What we're really looking for, in new drugs that are coming to market, are treatment options in these categories that have not existed with the traditional drugs. Or for conditions where there is treatment, but we have populations that are not receiving benefit or treatment that is reaching their true clinical outcomes and goals that their prescribers have for them. So the key difference we're looking for is better efficacy, and better performance that leads to better outcomes. With traditional drugs costing around $70 per month, and specialty drugs costing around $3,600 per month, if we are going to come out with a new drug, and it is going to be a specialty drug, and going to have that type of high cost, we wanna make sure that it's ultimately going to provide an additive value to what is currently on the market, that now is going to provide them with relief or better treatment for their disease.
As OptumRx Sr. Vice President of Specialty Pharmacy, Michael Zeglinski is responsible for leading the division’s strategy, sales efforts, product development, clinical and nursing programs, analytics and outcomes, as well as operations of 18 specialty pharmacies nationwide.
Few areas of pharmacy care services are more dynamic than specialty pharmacy. Nobody understands this better than Michael Zeglinski, Senior Vice President, Specialty Pharmacy, at OptumRx. We recently caught up with him to get his take on the latest trends in the marketplace and the unique approach Optum Specialty Pharmacy has to serving patients.
1. What do you see as the top challenge for specialty pharmacy management?
We all know drug cost inflation has greatly affected certain specialty medications. Our biggest challenge is to help alleviate these extra costs for our clients through a combination of management strategies and programs.
We are focused on both better outcomes for patients and total cost of care, so there’s a growing importance to have a comprehensive specialty strategy that considers both the pharmacy and medical benefits. Uniquely, we are able to leverage cutting-edge data and analytics to make the best site of service decisions and then collaborate with providers and patients to execute the strategy seamlessly.
2. You mentioned data. Can you expand on the role of data and technology in improving outcomes?
One important difference to note is that we have more and better data than is typically seen by a specialty pharmacy. With OptumIQ, we blend curated data, leading analytics and applied expertise in order to acquire a 360-degree view of the patient.
This enables us to engage through a multi-disciplinary care team that includes not just pharmacists handling pharmacy issues in a silo but also nurse advisors and other healthcare professionals. By identifying gaps in care across medical and pharmacy and ensuring seamless delivery of our condition management programs, this data-centric approach is vital to address complex conditions like diabetes, COPD and chronic kidney disease.
Moreover, our expertise in data and technology encourages stronger engagement not just with members, but with providers too. With a holistic perspective derived through better information, we can achieve stronger engagement across medical and pharmacy, leading to better outcomes.
3. How important is a patient-centric approach?
We put the patient at the center of everything we do. Our clinicians and pharmacists have the education, tools and resources to fully understand these complex therapies, the importance of remaining adherent and help mitigate any hurdles they might encounter.
Some side effects of specialty medications can be severe. That’s why we have programs like our Split Fill program for select cancer medications where patients are provided half of a regular prescription amount since many patients who can’t tolerate the medication switch prescriptions. These can be very expensive medications, so this cuts down on waste and saves significant amounts of money.
This is just one example. At a higher level, we are able to synchronize care, so that it’s easier for members to engage in our programs. To guide patients to actions that close gaps in care, we seamlessly integrate offerings like our live on-demand virtual pharmacist consultations and online videos featuring pharmacist insights and peers going through the same treatments.
4. What is the impact of biosimilars in the specialty pharmacy market?
The biosimilars market is growing rapidly. If Europe is a guide, the sales of biosimilars will continue to grow in the US, as physicians increase their rate of prescription, and patients become more comfortable using biosimilars.
Furthermore, the introduction of more biosimilars to each type of biologics is expected to increase competition and drive down prices. Several developers of originator products have pursued litigation, trying to stop biosimilars from entering the market place and there is no evidence this trend is waning. However, while this strategy might be somewhat effective in the short term, it is likely not effective in the long run.
5. What other trends are you keeping an eye on?
One trend worth noting is new specialty drugs coming to market to provide new treatments where we previously had only traditional drugs for treatment. An example of this is PCSK9 inhibitors versus traditional cholesterol medications.
Just this past year, we’ve seen an entirely new class of treatments for migraine. Historically, the medications that have been on the market may not have been able to help people control their migraines or provide them with relief. The new drug class, known as CGRP antagonists, appears promising but is expected to come at a much higher cost than existing migraine treatments. That’s why OptumRx already has a comprehensive management strategy in place for this new migraine drug class.