“As we look forward to the trends that will affect drug use and expense most substantially, pharmacy will remain a differentiating factor for clinical and financial organizational success.” — Steven Lucio, PharmD, BCPS, senior principal, pharmacy solutions, Vizient
Whether buying a home, planning a great vacation, or managing a hospital or health system, the key to making informed decisions is having the directional insights to confidently orchestrate a successful outcome. And for hospital executives who remain challenged by the impact of the COVID-19 pandemic on top of persistent protocol adjustments, service line changes and the most current treatment guidelines, the latest insights from Vizient pharmacy experts can help you to plan, budget and prepare for this critical time in our industry.
Pharmacy Market Outlook—published by Vizient each January and July—identifies top drugs by spend and provides forecasted drug prices overall, by service line and by drug class. The report also provides information on timely issues impacting hospital pharmacies as well as the greatest opportunities to accelerate growth and improve patient access and outcomes from the significant investment hospitals place in pharmaceuticals.
The importance and relevance of pharmacy to patient care has been validated time and again, most recently because of the response to the pandemic. “As we look forward to the trends that will affect drug use and expense most substantially, pharmacy will remain a differentiating factor for clinical and financial organizational success,” says Steven Lucio, PharmD, BCPS, senior principal, pharmacy solutions, Vizient.
Analyzing data from Vizient pharmacy program participants, the latest report found that remdesivir (Veklury), an anti-viral agent used in the treatment of COVID-19, tops the list of drugs by total member spend, replacing the anti-inflammatory adalimumab (Humira), which has fallen to the number two spot. Remdesivir, which came to market in 2020, currently makes up 3.42% (over $1 billion) of total Vizient member spend among all pharmaceuticals analyzed. Rounding out the top 10 drugs by member spend are #3 pembrolizumab (Keytruda), #4 ustekinumab (Stelara), #5 ocrelizumab (Ocrevus), #6 denosumab (Prolia, Xgeva), #7 infliximab (Remicade), #8 alteplase (Activase), #9 nivolumab (Opdivo) and #10 tocilizumab (Actemra).
The report also estimates that drug prices for the period between July 1, 2022, and June 30, 2023, will increase 3.09%. Looking at various areas of practice and service lines, Vizient expects a growth rate of 3.37% for specialty pharmacy drugs and 3.51% for medications used in pediatric populations. “We see the trend toward moderation of price increases persists, driven largely by a balance between the increased utilization of high-cost medications as well as generic entrants to the market and the additional approval and launch of biosimilar products,” says Carina Dolan, PharmD, MS, BCOP, senior director for clinical oncology and pharmaceutical outcomes, pharmacy solutions, Vizient. Dolan notes that the largest contributor to drug price increases is still adalimumab, and it will remain that way until calendar year 2023, when multiple biosimilar competitors are anticipated to arrive.
The challenges that have impacted hospitals during the pandemic have many executives looking to leverage, enhance and rebuild acute and nonacute resources and services for 2022 and beyond. “One of the most important things our members can do with this information is understand the importance of having a plan around these high-cost pharmaceuticals,” says Dolan. “Know where your use is and how much you spend.” The report highlights top areas of focus for hospitals and health systems when planning pharmacy strategies to promote organizational success, including:
Maximize the biosimilar opportunity—As the market gears up for several adalimumab biosimilars to enter the market next year, hospitals should ensure that future changes in use of branded adalimumab are driven by the uptake of biosimilars. Payers continue to impact clinical practice, including the implementation of white bagging strategies. As we approach the launch of the first adalimumab biosimilar, the payer community is implementing strategies regarding biosimilars that limit providers’ capacity to make independent formulary decisions. “Hospitals should implement strategies now to address the uptake of biosimilars as the market expands to include pharmacy benefit medications,” says Lucio.
Amplify the non-acute footprint—Though care has been shifting to ambulatory settings for some time, the pandemic accelerated that push. Medications that were historically on the inpatient side are being moved to outpatient, such as the move from infusion therapy to self-administration or oral therapy. Hospitals should have a fully integrated plan that includes specialty pharmacy, retail pharmacy and home infusion. “Hospitals will want to ensure that they have the right services and the right people in place to help execute on those services to help improve patient care,” says Dolan.
Align pharmacy with other critical stakeholders—Pharmacy has long been a key collaborator with physicians and prescribers, and the pandemic strengthened the alignment of pharmacy and supply chain. However, there are several areas where engagement and communication should be maximized for organizational success, including the alignment of pharmacy with managed care, finance and government relations. “It’s evident that hospital pharmacies have been leaders in many critical situations throughout the pandemic,” says Lucio. “They must now build and continue to grow relationships with the individuals who manage contractual relationships, finance and government relations/public policy.
The report is considered a snapshot in time as of the publication date. As the pandemic and health care continues to evolve, Vizient will provide updates to the report. In addition, because the specific composition of expenditures is unique for every hospital, Vizient also produces the Drug Budget Forecast Report, which provides members with individualized projected increases in drug expenditures based upon their unique purchase history.