WHAT THE FUTURE HAS IN STORE FOR TELEHEALTH AND VIRTUAL CARE

Telehealth and virtual visits saw a significant increase in 2020. They provided a way for providers to remain in contact with their patients without in-person office visits.

While telehealth visits will likely remain a viable option for many patients and providers, the industry has experienced a downward trend across the country. The rate of telehealth visits for private payers was:

• 15.7% in January
• 5.9% in February
• 5.6% in March

By March 2021, ambulatory care visits via telehealth across all payers declined approximately 18% as more patients returned to office appointments. 
 
“Even as patients are returning to inpatient visits, we anticipate a continued increase in ambulatory visits due to recent payment changes and payer requirements,” the Outlook explains. “Payers, including the Center for Medicare & Medicaid Services (CMS), are continuing to shift the site-of-care fee schedules for providers and services.”
 
As part of that trend, CMS increased the rates for outpatient visits in the finalized 2021 fee schedules for hospital outpatient departments and ambulatory surgical centers.

WHAT TO EXPECT FROM GENERIC DRUGS

Many Provista members who rely on pharmaceuticals take advantage of the Novaplus® Enhanced Supply Program, which brings increased stability and resiliency to the generic injectable market. As the industry’s longest-running private label program, Novaplus offers a dedicated inventory of essential medications and products that are critical to clinicians’ ability to provide immediate and high-quality patient care. 

The Outlook offers a look at generic drugs that were recently introduced:

• The first generic entrants for Ofirmev (intravenous acetaminophen) entered the market in Q4 2020. There are four generics on the market, with three more anticipated to become available this year.
• Miacalcin (calcitonin salmon injectable) is no longer protected by patents. In May 2021, Leucadia (part of CustoPharm) launched the first generic.
• Dimethyl fumarate (Tecfidera) now has 11 generic entrants. The generic market share is sharply rising, accounting for more than 70% of member spend on dimethyl fumarate from April 2020 through March 2021.
• A generic for fingolimod 0.25 mg oral capsule is expected in November 2021. A generic for fingolimod 0.5 mg oral capsule is not anticipated until 2023 or 2024, which raises the question of whether clinicians will administer two 0.25 mg generic capsules once they’re available.

A VIEW INTO THE SPECIALTY DRUG MARKET  

Specialty pharmaceuticals require a higher level of support, along with special distribution and administration in infusion centers or a home health setting. They are priced much higher than traditional drugs.

A drug is considered a specialty if it:

• Is used to treat rare or orphan diseases
• Has prices that CMS defines as high-cost, which are greater than $670 per month, per patient
• Requires a specialist prescriber
• Requires a “high touch,” such as frequent clinical monitoring for safety and efficacy
• Is sold as a limited distribution drug

Approvals on treatments for rare diseases are at an accelerated pace, according to the Outlook. Orphan and ultra-orphan therapies for disease states affecting fewer than 200,000 people in the U.S. are expected to account for 22% of all prescription drug sales by 2024.
 
Meanwhile, gene therapies, which can alter a patient’s DNA or RNA to treat the genetic causes of a disease, are some of the most expensive treatments.

THE OUTLOOK FOR BIOSIMILARS

Since the Pharmacy Market Outlook Winter 2021 edition, no additional biosimilars have been approved in the U.S. As result, the total number of licensed biosimilars remains at 29.
 
However, two additional biosimilars were brought into the supply chain earlier this year, bringing the total number of marketed agents to 19, which shows that progress continues to be made.
 
“Beyond the number of agents licensed and marketed, multiple legislative and regulatory actions transpired, which hopefully will continue to create a more hospitable market to biologic competition,” the Outlook predicts.
 
In the fall of 2021, biosimilar versions of pegfilgrastim and bevacizumab, and possibly the first approval of a ranibizumab competitor, may be available. Insulin could also see biosimilars.
 
“It is possible that at long last, there may be approvals of biosimilar insulin products,” according to the report. These could include insulin glargine and insulin aspart.

USING PHARMACEUTICALS TO IMPROVE PATIENT OUTCOMES

In 2022, Provista members can expect a 3.1% overall drug price increase, along with estimated drug price inflation rate increases of:

• 4.7%, disease-modifying antirheumatic drugs
• 4.68%, specialty drugs
• 3.25%, oncology drugs
• 3.18%, pediatric drugs
• 2.99%, plasma critical care products
• 2.96%, immunomodulators multiple sclerosis drugs
• 2.63%, diabetes-related medication spend
• 2.5%, infectious disease drugs

To see projected timetables for drug approvals and for more details on pharmaceutical forecasts, download the Outlook.