Oral Oncology Product Distribution: Determining a Strategy with Specialty Pharmacies

Specialty pharmacy offers drug manufacturers important solutions for self-administered oncology drugs. With the increased use of the specialty pharmacy channel, specialty pharmacies are becoming a norm for standard operating procedures. For instance, all of the oral oncology products launched in 2011 and 2012 are distributed through specialty pharmacies. A number of factors are driving this trend, including:

• Increased high-cost specialty product volume, especially oral oncolytics;
• Pipeline shifts to oral specialty products presaging future marketed specialty drug growth;
• Growing physician acceptance of orals;
• Manufacturer desire to improve safety, supply chain control and patient access;
• Payer demand to control specialty spend and improve adherence and compliance

According to EvaluatePharma, in 2016, seven of the top 10 best-selling drugs (by revenue) are projected to be specialty drugs compared with three in 2010. Physicians have become more willing to prescribe oral oncology therapies despite there being no financial incentive to their practice—in part, because of the services offered by specialty pharmacies.

Manufacturers use specialty pharmacies to gain greater control over the supply chain, and provide the clinical care or training—with oncology expertise—that the patient may not otherwise receive.

Payers have also identified specialty pharmacies as an important part of care for patients and at the same time controlling specialty spend. Payers also may be restrictive in which specialty pharmacy their members can access.

At least 18 months before launch, manufacturers may want to begin to incorporate a channel strategy into their commercialization plans since it is necessary to understand the opportunities and risks of strategic options in choosing channel partners.

Factors for manufacturer’s to consider when determining a specialty pharmacy network include:

• Distribution control versus patient access trade-offs (fewer specialty pharmacies allow for greater control, but may cause access issues; larger networks may result in problems trying to coordinate all specialty pharmacies so patients get a consistent experience), which should factor in drug characteristics (safety issues, administration complexity, cost) and patient population size
• Desired practice and manufacturer services. Hub services can be helpful in alleviating practice burden, and specialty pharmacies may provide valuable market data as part of their contract.

• A limited strategy for large patient populations could result in a bottleneck for obtaining the drug and cause issues with higher patient cost-sharing due to distribution through non-payer-preferred specialty pharmacies, while a very limited distribution strategy may be warranted for drugs with very small patient populations, although these may require programs and policies in place to ensure access and financial support for patients with non-overlapping manufacturer and payer specialty pharmacy networks.
• Access to market data is also important for manufacturers, as specialty pharmacies do not regularly report this information to data aggregators. Establishing data submission as part of an SP contract or working with hub services is important in order to know how a product is being used and to identify issues and opportunities.

The key to success when engaging a specialty pharmacy is to ensure that the specialty pharmacy is effective, efficient, and experienced in oncology—requiring nominal paperwork, avoiding redundant or unnecessary administrative steps, and offering expert-level clinical oncology support. Overall, the specialty pharmacy must be reliable and easy for oncology patients and oncologists to use lest they also become a barrier to what they promise to bring, optimal access to complex and costly medications.

By: Deni Deasy Boekell, Senior Director, Commercial Planning, Kantar Health

This blog is an excerpt from a full length article featured in the February issue of OBR green. You can visit the full length article here:

The-Evolving-Dynamics-of-Specialty-Pharmacy-in-Oncology.