Pharmaceutical Commerce - November/December 2016 - 16


Brand Communications
opportunity, makers of branded therapies
know that gaining a foothold in highly
regulated class of trade is particularly
challenging, thanks to a confluence of
complex factors that are at play in the LTC
arena. To overcome the many barriers,
manufacturers need to deliver strong
messaging that underscores the clinical and
long-term economic advantages of their
branded product particularly with regard to
generic competitors in the same therapeutic
class. "You really have to sell the full value
of your product over the entire episode
of care," says Frank Grosso, RPh, CEO,
executive director, ASCP.
"If your brand-name drug is a me-too
drug with little discernible benefit over
generic, then you really don't have a
sustainable market in LTC-because
managing drug costs is the predominant
factor when there is no discernible reason
to justify keeping patients on the branded
therapy," says Grosso. "Drug companies
must demonstrate longitudinal value over
the entire episode of care for a brand-
that's a very different way of marketing
for pharma companies but creates huge
opportunity."
"Today, roughly 57% of those in LTC
settings are Medicare, Medicaid and
so-called 'dual eligible' patients (those
who are covered by both Medicaid and
Medicare), while 29% are covered by private
insurance, and the remainder are privatepay patients," says Grosso. He notes that the
57% who have Medicaid or Medicare or
are dual eligible don't have access to all of
the 746 Medicare Part D plans that are in
existence today. "Rather, they typically only
have access to the 231 so-called 'benchmark
plans' (a subset of the total available Part D
plans on the market today)," says Grosso.
"The benchmark plans are lower-cost plans
with more restrictions in terms of formulary
designations and prior authorization
restrictions, and in the post-acute setting,
the pressure is on for physicians to only
prescribe through those 231 benchmark
plans to avoid out-of-pocket costs for lowincome beneficiaries and skilled nursing
centers."
"It's not an insurmountable task for
brand teams, but it requires targeted effort
to get the product on as many of the 746
traditional Part D plans, and the 231 lowercost benchmark plans, as well," he adds.
John Doyle, DrPH, MPH, SVP at
QuintilesIMS, notes that analyzing the
continuum of care for LTC residents is
essential to marketing success. "Nowhere is
the mantra to make sure the 'right patient
gets the right drug at the right time' more
important than in the LTC setting. It's
extremely important that drugs fit well
into the prevailing disease-management
protocols and pathways and the individual
patient's overall care plan." "They should
be modeling their products using market
research, interviews, electronic medical
records and physical chart reviews in
concert with the LTC to take stock of what
care and risk really looks like today in the

ASCP Membership Practice Settings

Consulting pharmacists engage with a wide variety of healthcare facilities. Credit: ASCP

LTC setting, and they should be tracking
outcomes and correlated cost data," he
adds. "The goal is to simulate 'what the
situation looks like with my product on
your formular y.'" He notes that this
approach is already being used in some
health technology assessments integrated
delivery networks (Kaiser Permanente and
others) so drug companies "don't need to
reinvent the wheel-they just need to align
their approach with the specific challenges
and opportunities in the LTC setting."
Because there are so many HCPs
with prescribing authority, including
geriatricians, nurse practitioners and
p hy s i c i a n a s s i s t a n t s w h o a l s o h ave
prescribing authority, pharma companies
do well to pay closer attention to all of them.
"Pharmaceutical companies are increasingly
deploying a dedicated LTC sales force to
provide this information directly to LTC
health care practitioners and pharmacies,"
says Binaso of MHA.
LTC pharmacy services
"As the healthcare industry increasingly
moves to a pay-for-performance
model, LTC pharmacy services become
increasingly vital to successful patient
outcomes," Stephen Hendrickson, SVP of
sales, community & specialty pharmacy
at AmerisourceBergen. Among the valueadded services a dedicated LTC pharmacy
can provide:
* formulary management
* drug utilization review and training for
the LTC staff
* u nit-of-use packaging, such as blister
("bingo") cards, cassettes and other
packaging
* IV medications
* specialized drug-delivery formulations
and compounding services
* manage reports, forms & prescription
ordering supplies as necessary for facilities
"Unit-dose packaging, especially, has
evolved to become highly specialized and
truly makes it easier for patients to access
and stay adherent to their medication," says

16 Visit our website at www.PharmaceuticalCommerce.com November | December 2016

Hendrickson.
"In addition to providing a range
of medication-management ser vices
throughout the continuum of care, LTC
pharmacies manage medication records,
clarify orders, manage emergency
medications, provide holistic clinical
review, and they package medications in
unit doses or in compliance packaging and
prepare IV products," adds Rich McKeon,
VP, McKesson's Alternate Site Pharmacy.
"As far as ongoing drug-regimen reviews
and ongoing medication management is
concerned, LTC pharmacies and consultant
pharmacists also play an essential role in
terms of quality assurance checks, especially
with regard to the use, potential overuse
and complex drug-drug interactions that
can occur when seniors are taking so
many medications, particularly to prevent
excessive use of narcotic pain medications,
antibiotics and psychotropic medications."
Specialty on the rise
As with pharmaceuticals in all other
healthcare settings, the impact of specialty
pharmaceuticals to treat chronic conditions
is on the rise in LTC. The Managed Health
Care Associates 2016 Independent LongTerm Care Member Study analyzed LTC
pharmacy dispensing data nationally from
1,231 pharmacies between 2014 and 2015.
The study shows the "total annual
specialty pharmaceutical spend has grown
by 59%, and brand specialty pharmaceutical
spend grew by 66-67% in each of the last
two annual MHA studies," says Binaso.
Specific findings include:
* HIV medications-13% increase
* I mmune g lobu lin t herapy - 71%
increase
* Hepatitis C treatments-25% increase
(Note: In the 2015 study, reflecting the
period when several hepatitis C treatments
were introduced to the market, growth in
this category had been 289% that study
year)
* Multiple sclerosis medications-13%
increase
* I nf lammator y conditions (such as

rheumatoid arthritis, ulcerative colitis and
others)-37% increase
On the plus side, the MHA study
confirms that challenges that limit patient
access to specialty drugs-such as limited or
preferred distribution and payer networks
for today's costly specialty medications,
and the extra burden of compliance
with Risk Evaluation and Mitigation
Strategies (REMS)-are not necessarily
insurmountable in LTC facilities. However,
"ensuring access to specialty medications
continues to be a major challenge for LTC
facilities as LTC pharmacies are often
excluded from participating in limiteddistribution pharmacy networks," says
MHA's Binaso. "We continue to see an
overall lack of understanding of the nuances
of long-term regulations, the patient
population being serviced, and transition
of care issues by both the pharmaceutical
company and their contracted limiteddistribution pharmacies."
Sometimes, LTC pharmacies turn
to third-party partners to assist with
formulary development. "Typically, longterm care facilities want to work with fewer
and a consistent cadre of distributors for
all medication, equipment and healthcare
products. By working through their
distributors to drive product access needs,
providers can feel confident that they have
optimal access to the products they need
in the most convenient setting for their
operation/patient care," says Akin Odutola,
SVP, Specialty & Branded Product Access,
AmerisourceBergen.
Likewise, McKesson's PATH Pro is a
geriatric formulary-management program
for post-acute therapeutics, which "helps
LTC pharmacies to reduce inventor y
costs, standardize care processes and build
stronger, differentiated partnerships with
skilled nursing facilities," says McKeon.
"The program creates drug formularies
from a clinical perspective, taking into
account geriatric considerations, such as
the physiological changes of aging, drug
interactions and side effects profiles that are
particular to older patients, in order to help
LTC pharmacies to purchase and dispense
those products that have the safest and most
effective profile and competitive price for
the geriatric patient population."
In addition to determinations for drugs
that should be on preferred drug lists
across 20 therapeutic classes, the McKesson
service provides easy access to clinical
research and independent review of safety
profiles, up-to-date safety warnings and
monographs related to individual drugs,
helping facilities to reduce prescription
drug costs and standardize medications
across all of their facilities.
"Wi t h a c re d i b l e p re f e r re d d r u g
list developed specifically for geriatric
patients, consultant pharmacists are in a
better position to standardize drugs across
multiple facilities, which helps pharmacies
w ith inventor y forecasting and cost
reduction," adds McKeon of McKesson.
"Clinical studies that indicate increased


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