Pharmaceutical Commerce - May/June 2017 - 9

Top News
Zipdrug sharpens its focus on medication adherence through
a drug-delivery platform
Awarded a "50+ Innovation Leader" award by AARP and MedCity News
Zipdrug, a venture-capital-backed
new business launched a couple years ago,*
started out with a straightforward idea:
improve drug dispensing from pharmacies
by offering to deliver the prescription to
the patient's home for a $10 fee. Deliveries
were to be carried out by a staff of trained
couriers who could be responsible for (for
example) temperature-sensitive drugs and
be HIPAA-compliant for patient privacy.
That model, intriguingly, is being pursued
in various forms by newer star tups,
including one in Zipdrug's native New York,
called Capsule (Capsulecares.com); but in
the meantime, Zipdrug has moved on.
Zipdrug's current iteration, according
to Stu Libby, founder and CEO, is to align
* http://pharmaceuticalcommerce.com/latest-news/
zipdrug-from-the-pharmacist-to-the-patient-via-alocal-courier/

closely with health plans to accomplish
three goals: better adherence, cost savings
for patients, and a better patient-care
experience (valuable to both Zipdrug
and to its health-plan partners). Health
plans want better adherence in pursuit of
the goal of lower overall healthcare costs;
they also want to differentiate themselves,
throug h better patient satisfaction,
from the mostly economic issues when
comparing one health plan to another.
Zipdrug's "medication delivery platform"
n ow co n s i s t s o f a m e t h o d o l o g y t o
identify which pharmacies can provide a
prescription at the lowest copay cost to a
patient. Prescriptions are filled much of the
time at independent pharmacies who have
their own courier service (thus obviating
Zipdrug's need for that). The Zipdrug
platform can exist as a smartphone app,

but Libby notes that the biggest economic
advantages currently are for Medicare
Advantage (which is of course for the
elderly, but who tend not to be hip to the
latest apps). Thus, the award from AARP,
the retired-persons organization.
Libby says that a large part of the
company's education over the past year
has been in discovering how difficult
it is to obtain the best price (on a copay
basis) for drugs, and how eager health
plans are to provide better patient service.
An (undisclosed) partnership with one
regional health plan is now in place, and
"more are in the pipeline," he says. The
company has delivered "hundreds of
thousands" of prescriptions over the past
year and because it is not doing the courier
delivery, can operate essentially wherever a
health plan partner does.

Quite a menagerie of delivery, dispensing
or cost-comparing pharmacy services have
popped up over the past couple years,
attracting Silicon Valley-type venture
capital (presumably on the theory that the
business is ripe for disintermediation a la
Amazon): Capsule, RobinHealth, PillPack,
ScriptDash and others, and many more
outside the US. Another prescription
support venture, ZappRx, got a $25-million
injection of capital in April from Qiming
US Healthcare Fund, a Seattle-based firm,
and other West Coast investors. Depending
on their business model, they can either
enhance brick-and-mortar pharmacy, or
mail order, or compete with them. Is there
a place for pharma in all this? "We see ways
in which key stakeholders in drug delivery
are misaligned," says Libby, "and this can be
changed."

Vaccine experts ponder a future supply chain
A growing process burden is forcing a modernized approach
The latest issue of Vaccine, an Elsevier
journal with open-access content, devotes
177 pages to one theme: how today's global
vaccine supply chains function, and how
they can be improved. Vaccines are notable
in that many (but not all) require 2-8°C
temperature control-and that stability
in out-of-range temperatures can quickly
be lost, deactivating the drug. While the
bulk of the issue's content is devoted to
public-assistance efforts in the developing
world, there are notable lessons for
anyone operating supply systems for any
temperature-controlled drug. Moreover,
as four authors from UNICEF point
out in a meta-study of recent vaccine
projects, one-third of vaccine inventories
are exp ose d to b e low-sp e cificat ion

temperatures in "wealthier" countries;
and an even higher proportion-38%-
are overly cooled during shipping. Both of
these figures are higher than those seen in
less-developed countries, a condition the
authors attribute to the possibility of more
temperature monitoring activity (i.e., better
identification of what had been there all
along).
Today's vaccine supply chain grew
out of efforts that began in the 1960s to
address smallpox (a successful eradication
eventually) and then polio (an ongoing
campaign). Along the way, vaccines were
essentially handled in their own supply
chain, with refrigerated depots, insulated
containers and specialized log istics
processes distinct from the range of general

healthcare product deliveries. There are now
efforts to integrate vaccine shipments with
other healthcare products, but at the same
time, the volume and types of vaccines have
grown by 50% since 2007. (The fact that an
increasing number of biopharma drugs also
require refrigeration seems to be outside
the scope of the studies.) A common figure
in the activity is that 40% of the cost of a
typical vaccination program is taken up by
the vaccines themselves. A 1% reduction
in vaccine wastage is estimated to save $50
million by 2020. And, like commercial
drug deliveries in some parts of the
developed world, temperature monitoring
is only a sometimes thing in vaccines in the
developing world.
In "Gavi-eligible" countries (Gavi, the

Global Vaccine Alliance nonprofit, has
selected some 55 underdeveloped countries
that meet its application criteria), the state
of cold chain equipment is poor: 50%
depend on early-generation refrigeration
equipment that often freezes vaccines; 20%
have little or nothing and another 20% have
significant breakdowns, leaving only 10%
with the latest technology. McKinsey &
Co. has worked with Gavi on a Cold Chain
Equipment Optimisation Platform since
2015 to improve this situation. Advances
such as using solar direct-drive refrigeration
will replace earlier, fuel-burning or "icelined" refrigerators (set up to deal with
intermittent electrical power). Electronic
temperature-monitoring equipment will
also become more widespread.

Amgen biosimilars report assesses current risks
Reimbursement is just one of the issues facing biosimilar commercialization in the US
In conjunction with the Academy of Managed Care
Pharmacy (AMCP) Managed Care & Specialty Pharmacy
Annual Meeting (Denver, Co, March 27-30), Amgen has
released the fourth edition of its Trends in Biosimilars
Report. The study is a useful compilation of recent research
and studies on commercialization and distribution issues
but, aside from statements from its editorial board members,
does not present new survey data.
One of the surprising findings in the report (based
on earlier research by the firm Avalere Health) is that, for
Medicare patients still in the coverage gap between when
full coverage under Medicare Part D kicks in, a biosimilar
product can cost the patient more out-of-pocket than

the originator drug. The reason: biosimilars are lumped
together with generics in Medicare reimbursement policy,
which have a less generous schedule for coverage.
Other commercial challenges:
- Multiple biosimilars of the same reference product
will need to be tracked electronically to tie adverse-event
reporting (if any) to the appropriate drug, but some hospital
recordkeeping systems are not set up to do this. As a benefit
under pharmacy-benefit management systems, biosimilars'
NDC codes are tracked; but when a drug is dispensed in
a hospital setting, it's usually tracked as a medical benefit
under the Healthcare Common Procedure Coding System

(HCPCS); no NDC is used and thus no specific biosimilar
identification.
- In a like manner, manufacturers may choose to
employ different delivery methods (vial, prefilled syringe,
etc.), which will present both tracking issues and raise the
importance of patient education.
Two of the four biosimilars on the US market today
were launched "at risk," meaning that patent ownership
issues remain to be resolved even as the products are being
dispensed. Six more products have "active filings" with FDA
that are expected to be acted on during this year.

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