Article

First Look at Prescription Drug Price Increases for Ambulatory Care

June 27, 2023
Hands holding packaged syringes

The healthcare landscape is experiencing a change in who’s providing care. The “Pharmacy Market Outlook” from Provista’s contracting partner Vizient predicts a continual move from acute care to non-acute care. The insights can help Provista members and other healthcare providers know what to expect for their businesses over the next year.


“This profound shift in healthcare delivery will drive more patient care to physician offices and clinics, hospital outpatient departments and ambulatory surgery centers, while expediting patient visits with virtual visits,” according to the Market Outlook.


The shift is significant. The Market Outlook estimates the healthcare industry will see a 14% increase in overall ambulatory service care over the next decade. That’s because more patients are choosing, and will continue to choose, ambulatory care instead of acute care in hospitals. 

10 BIOSIMILARS BY THE END OF 2023

Adalimumab continues to rank number one for biosimilars, accounting for 4.78% of all Provista and Vizient member spend. Adalimumab — or brand name Humari — is used to treat rheumatoid arthritis, psoriatic arthritis, Crohn's disease and other conditions. Payer preference will largely impact the utilization of biosimilar adalimumab, according to the Market Outlook.
 
The launch of adalimumab in the self-administered outpatient space is expected to significantly impact healthcare systems, Provista members and members’ patients. Provista says a total of 10 biosimilar products will likely be available by the end of 2023. Currently, seven are approved, with three more anticipated by year’s end.

“Conversations with physicians and the impacted service lines should take place now to align understanding and preference for biosimilar products,” the Market Outlook states.
Primary attributes likely to impact the utilization of biosimilars include:

  • Formulation
  • Delivery device
  • Interchangeability
  • Payer preference
  • Patient assistance programs 

“As seen with infliximab (a drug used to treat autoimmune diseases) when the originator product is preferred by payers over the biosimilar, the uptake of the biosimilar products will be minimal until biosimilar parity by the payer is updated,” according to the Market Outlook. 

CONFRONTING NON-ACUTE MEDICATION SHORTAGES

Drug shortages are a continuing challenge. “Higher rates of drug shortages occur when products are used in more than one indication due to increasing demand,” the Market Outlook explains. “The patients on therapy for the initial indication may have challenges obtaining their medication leading to a gap in therapy or change in medication.”
 
For example, unprecedented demand for glucagon-like peptide 1 (GLP-1) receptor agonists, which are used for weight management, have resulted in widespread supply shortages for liraglutide (Saxenda®) and semaglutide (Wegovy®). The utilization of semaglutide has increased tremendously. In addition, the GLP-1 shortage has resulted in inadequate supplies of products such as Ozempic® and Victoza®, which are indicated for glycemic control.
 
“GLP-1 medications have become a cornerstone of the pharmacologic management of type 2 diabetes, and the inability to access drug supply can have serious ramifications for patients living with a life-threatening chronic condition,” according to the Market Outlook.
 
Treating obese patients with either liraglutide or semaglutide costs more than $1,300 per month, the Market Outlook notes.

“The growth in the specialty pharmacy market is expected to continue its robust pace, with an expected 8% annual growth for drugs in the specialty pipeline through 2025. 

—Pharmacy Market Outlook”

CONSISTENT GROWTH OF SPECIALTY PHARMACEUTICALS

Specialty medications continue to represent the largest and fastest-growing area of prescription drug expenditures. Provista defines specialty medications as products requiring a specialty or limited pharmacy distribution channel, or medications requiring extensive patient education and monitoring. The Provista specialty pharmacy list includes 600 unique drugs and is equally divided between injectable and non-injectable therapies.
 
The expected overall price inflation rate for specialty drugs is 4.33% from July 1, 2023, through June 30, 2024. This represents a higher inflation rate than the predicted rate for all pharmaceuticals, which is 3.78%.
 
Specialty pharmacies grew by 315% between 2015 and 2021, with about one-third of the total growth generated from hospital or health system-owned specialty pharmacies. Meanwhile, 85% of integrated delivery networks and health systems had their own specialty pharmacy program at the end of 2022, up from 70% in 2019.
 
Specialty medications made up 55% of total drug spend in 2021, which is nearly double from 28% in 2011. “The growth in the specialty pharmacy market is expected to continue its robust pace, with an expected 8% annual growth for drugs in the specialty pipeline through 2025,” the Market Outlook projects.
 
HELPING NON-ACUTE CARE RUN SUCCESSFUL PHARMACY PROGRAMS
Provista offers one of the most successful pharmacy portfolios in the industry for members in non-acute healthcare. As a leading group purchasing organization (GPO) that predicts and analyzes market changes, Provista is working to let members know what to expect with drug prices over the next year.
 
Plus, to help members avoid drug shortages while benefiting from competitive prices, Provista offers Novaplus®. The private label program delivers financial value, quality and support for pharmaceuticals, as well as medical-surgical products. Provista members leverage Novaplus for consistent access to prescription medications and market-competitive pricing for almost 50% of the drugs considered to be in short supply today.
 
On average, Novaplus pharmaceutical products deliver a 20% value for members.

You Might Also Like

Ready to Get Started?

Take the next step to start saving.

Become a Member