Hospital Pharmacy - December 2017 - 721

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editorial2017

HPXXXX10.1177/0018578717735643Hospital PharmacyWalker

Editorial
Hospital Pharmacy
2017, Vol. 52(11) 721-722
© The Author(s) 2017
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https://doi.org/10.1177/0018578717735643
DOI: 10.1177/0018578717735643
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Knowing What Is Coming:
The Importance of Monitoring
the Pharmaceutical Pipeline
Scot Walker1
The cost of drugs has remained a popular media topic for
several years. For the past 3 years, annual expenditures on
drugs represented 10% of total health care costs.1,2 Total drug
costs in the United States were 5.8% higher in 2016 compared with 2015.3 Factors that influence drug expenditures
include cost and utilization. Guideline changes and new uses
for a drug can increase utilization. New generics and competition within a branded drug class can decrease unit cost,
while supply issues can increase costs.3
Utilization went up by only 1%, suggesting the primary
reason for the increase in drug expenditures is due to higher
acquisition cost. From 2011 to 2015, branded drugs represented 71% to 74% of annual expenditures, even as the number of branded prescriptions decreased 20% from 2011 to
2015. So despite 83% of prescriptions being for generic
drugs, only 11% of the cost for drugs in 2015 was due to
generics. The third piece of the drug cost puzzle is branded
generics, which represented only 5% of prescriptions in
2015, but 16% of costs. So while utilization of branded
generics is low, they do contribute to the increase in costs.4
A key driver of the increase in the cost of branded drugs is
specialty medications. Specialty medications are drugs that
are high cost, usually a biologic and/or require special monitoring. The drugs may be given orally or by injection. It has
been estimated that 70% of the increase in drug costs from
2010 to 2015 was due to specialty medications. In 2015, specialty medications represented 36% of total drugs costs, up
from 24% in 2010.4
In cases of managed care prescriptions, a new drug may
be placed on a higher tier. Pharmaceutical manufacturers
have sought to make it easier for patients to obtain the drug
by provision coupons, vouchers, and discount cards to reduce
copays. This ends up being more expensive for the drug budget, because a higher cost drug replaces a preferred lower
cost alternative. So knowledge of when new drugs are coming and their potential formulary status can help predict when
copay reduction programs may be put in place.5
Because drug expenses represent a significant part of
health care costs, it is a strategic necessity to monitor the
pharmaceutical pipeline. Knowledge of when new drug
classes are coming or new products to compete with established products is needed to plan a discussion on the drug's
formulary status and to be able to develop special procedures

for monitoring or liming availability. An expensive injectable biologic that requires special monitoring and is only
available through a limited distribution network will not only
impact a pharmacy's drug budget but also personnel to procure the drug and manage it. By knowing whether other
drugs in the same class or more convenient administration
may become available in the near future, a plan can be developed to meet the needs for a patient population. Justifications
can be developed to implement incremental value-based formulary decisions6 and restricted access, or to plan for valuebased negotiations for the new drug.7
The need to monitor the pharmaceutical pipeline can be
seen in the topics inclusion in national meetings and publications. The annual drug expenditures report by American
Society of Health-System Pharmacists (ASHP; Rx Forecast)
regularly includes a section of new drugs projected to be
approved in the next year. The Academy of Managed Care
Pharmacy meetings include multiple presentations on the
pharmaceutical pipeline. Presentations are divided into conventional drugs, specialty medications, and even separate
high-cost therapeutic areas such as oncology.
Various methods to monitor the pharmaceutical pipeline
have been used over the years. Simple lists and spreadsheets
provide some basic information. Some very in-depth and
costly services are also available that provide analyses by
health care professionals, researchers, and lawyers of a
drug's potential impact. Hospital Pharmacy carries wellwritten and researched reviews of new drugs from the
Formulary Monograph Service in each issue. Beginning in
June 2017, I started providing a brief review of a drug class
or therapeutic class in Hospital Pharmacy. Using information from the Prescribe Right database, each review gives a
snapshot of a group of potential new drugs in late stages of
development. The reviews are designed to keep you informed
about drugs in development that you will be discussing.

1

Prescribe Right, LLC, Wildwood, MO, USA

Corresponding Author:
Scot Walker, Prescribe Right, LLC, 1602 Westglen Farms Dr, Wildwood,
MO 63011, USA.
Email: scot.walker@prescriberight.com


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Table of Contents for the Digital Edition of Hospital Pharmacy - December 2017

Knowing What Is Coming: The Importance of Monitoring the Pharmaceutical Pipeline
In Reply to “Postoperative Pain Management With Liposomal Bupivacaine in Patients Undergoing Orthopedic Knee and Hip Arthroplasty at a Community Hospital”
Letter to the Editor on “Enzyme Replacement or Substrate Reduction? A Review of Gaucher Disease Treatment Options”
Response to Letter to the Editor on “Enzyme Replacement or Substrate Reduction? A Review of Gaucher Disease Treatment Options”
Commentary: Exploring Novel Approaches to Staff Rewards and Recognition
Edaravone
Pharmaceutical Pipeline Update
BACE Inhibitors and Tau Protein Targeting Drugs in Prevention of Alzheimer’s Disease
Direct and Indirect Remuneration Fees: The Controversy Continues
Factors Associated With Burnout Among US Hospital Clinical Pharmacy Practitioners: Results of a Nationwide Pilot Survey
In Vitro Evaluation of Eslicarbazepine Delivery via Enteral Feeding Tubes
Evaluation of Insulin Use and Hypoglycemia in Hospitalized Elderly Patients
Production Standard and Stability of Compounded del Nido Cardioplegia Solution
Lumbar Spine Surgeries and Medication Usage During Hospital Stay: One-Center Perspective
Hospital Pharmacy - December 2017 - 713
Hospital Pharmacy - December 2017 - 714
Hospital Pharmacy - December 2017 - 715
Hospital Pharmacy - December 2017 - 716
Hospital Pharmacy - December 2017 - 717
Hospital Pharmacy - December 2017 - 718
Hospital Pharmacy - December 2017 - 719
Hospital Pharmacy - December 2017 - 720
Hospital Pharmacy - December 2017 - Knowing What Is Coming: The Importance of Monitoring the Pharmaceutical Pipeline
Hospital Pharmacy - December 2017 - 722
Hospital Pharmacy - December 2017 - In Reply to “Postoperative Pain Management With Liposomal Bupivacaine in Patients Undergoing Orthopedic Knee and Hip Arthroplasty at a Community Hospital”
Hospital Pharmacy - December 2017 - 724
Hospital Pharmacy - December 2017 - Letter to the Editor on “Enzyme Replacement or Substrate Reduction? A Review of Gaucher Disease Treatment Options”
Hospital Pharmacy - December 2017 - 726
Hospital Pharmacy - December 2017 - Response to Letter to the Editor on “Enzyme Replacement or Substrate Reduction? A Review of Gaucher Disease Treatment Options”
Hospital Pharmacy - December 2017 - 728
Hospital Pharmacy - December 2017 - Commentary: Exploring Novel Approaches to Staff Rewards and Recognition
Hospital Pharmacy - December 2017 - 730
Hospital Pharmacy - December 2017 - 731
Hospital Pharmacy - December 2017 - Edaravone
Hospital Pharmacy - December 2017 - 733
Hospital Pharmacy - December 2017 - 734
Hospital Pharmacy - December 2017 - 735
Hospital Pharmacy - December 2017 - 736
Hospital Pharmacy - December 2017 - BACE Inhibitors and Tau Protein Targeting Drugs in Prevention of Alzheimer’s Disease
Hospital Pharmacy - December 2017 - 738
Hospital Pharmacy - December 2017 - 739
Hospital Pharmacy - December 2017 - Direct and Indirect Remuneration Fees: The Controversy Continues
Hospital Pharmacy - December 2017 - 741
Hospital Pharmacy - December 2017 - Factors Associated With Burnout Among US Hospital Clinical Pharmacy Practitioners: Results of a Nationwide Pilot Survey
Hospital Pharmacy - December 2017 - 743
Hospital Pharmacy - December 2017 - 744
Hospital Pharmacy - December 2017 - 745
Hospital Pharmacy - December 2017 - 746
Hospital Pharmacy - December 2017 - 747
Hospital Pharmacy - December 2017 - 748
Hospital Pharmacy - December 2017 - 749
Hospital Pharmacy - December 2017 - 750
Hospital Pharmacy - December 2017 - 751
Hospital Pharmacy - December 2017 - In Vitro Evaluation of Eslicarbazepine Delivery via Enteral Feeding Tubes
Hospital Pharmacy - December 2017 - 753
Hospital Pharmacy - December 2017 - 754
Hospital Pharmacy - December 2017 - 755
Hospital Pharmacy - December 2017 - 756
Hospital Pharmacy - December 2017 - 757
Hospital Pharmacy - December 2017 - 758
Hospital Pharmacy - December 2017 - 759
Hospital Pharmacy - December 2017 - 760
Hospital Pharmacy - December 2017 - Evaluation of Insulin Use and Hypoglycemia in Hospitalized Elderly Patients
Hospital Pharmacy - December 2017 - 762
Hospital Pharmacy - December 2017 - 763
Hospital Pharmacy - December 2017 - 764
Hospital Pharmacy - December 2017 - 765
Hospital Pharmacy - December 2017 - Production Standard and Stability of Compounded del Nido Cardioplegia Solution
Hospital Pharmacy - December 2017 - 767
Hospital Pharmacy - December 2017 - 768
Hospital Pharmacy - December 2017 - 769
Hospital Pharmacy - December 2017 - 770
Hospital Pharmacy - December 2017 - 771
Hospital Pharmacy - December 2017 - 772
Hospital Pharmacy - December 2017 - 773
Hospital Pharmacy - December 2017 - Lumbar Spine Surgeries and Medication Usage During Hospital Stay: One-Center Perspective
Hospital Pharmacy - December 2017 - 775
Hospital Pharmacy - December 2017 - 776
Hospital Pharmacy - December 2017 - 777
Hospital Pharmacy - December 2017 - 778
Hospital Pharmacy - December 2017 - 779
Hospital Pharmacy - December 2017 - 780
Hospital Pharmacy - December 2017 - 781
Hospital Pharmacy - December 2017 - 782
Hospital Pharmacy - December 2017 - 783
Hospital Pharmacy - December 2017 - 784
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