Anshul Agarwal co-wrote this blog post with Nakul Korde.
Amid the growing concerns and uncertainty of COVID-19, the CDC has issued guidance for individuals to stockpile several weeks of medications and supplies. However, this is easier said than done, especially for oncology and specialty medications as many of them have stringent administrative, accessibility and logistical barriers. Given the global spread and impact of COVID-19, supply chain disruptions for these drugs cannot be ruled out. In such situations, it’s natural for patients to be concerned about getting their prescriptions filled on time and with minimal hassles and exposure.
To ensure steady and uninterrupted drug availability and streamline access to drugs for patients, all stakeholders—including payers, providers and pharmacies—are constantly evolving their policies and operating models. In this blog, we’ve summarized the implications of these policy and operating model updates on drug distribution channels and support programs for oncology and specialty pharma manufacturers, and discuss what they can do to plan, prepare and respond.
1. Specialty distributor and pharmacy operations: Most specialty distributors and pharmacies are continuing to function with minimal disruptions. However, they are experimenting with some operational changes to keep up with the evolving COVID-19 situation:
- Contactless delivery: Some specialty pharmacies have started to relax the signature requirements for deliveries and offer electronic signature options, enabling them to offer contactless delivery. This is particularly important for oncology and some rare disease patients who are among the most at risk.
- Remote staff: Most specialty pharmacies have had their non-essential staff—including but not limited to patient care coordinators and reimbursement staff—shift to a work-from-home model.
- Free drug delivery: Some retail pharmacies such as CVS and Walgreens have now started to offer free home delivery. This could be particularly useful for patients whose treatment involves a combination of specialty and retail medications.
Pharma manufacturers should plan to establish a monitoring process to proactively identify any changes in the drug distribution and patient support operations. This could be established leveraging a combination of data analytics and channel partner relationships, including:
- Data and analytics: Track product inventory across the supply chain, along with the channel partner service performance and outcome indicators such as time from enrollment to shipment, abandonment rate, etc.
- Channel partner relationship: Establish a weekly cadence with the channel partners to proactively learn about any changes in their operating and service models and standards.
Early detection and knowledge of any potential issues will help pharma manufacturers to prepare, mitigate and appropriately communicate any impact to the providers, patients and other channel partners.
2. Changes to provider buy-and-bill and in-office dispensing: Many hospitals and clinics have limited access to the general public and are implementing several measures to protect patients from exposure to COVID-19 while in transit or during visits. These measures will also help providers reduce the burden of resources needed to administer a therapy. They include:
- Temporarily pausing in-house pharmacy operations and transferring patient prescriptions to an outside pharmacy
- Delaying elective procedures and surgeries, and choosing oral treatments when clinically appropriate
- Supporting home infusion under virtual supervision (more on this in an upcoming blog post)
Pharma can expect a temporary decline in demand for buy-and-bill products and potentially a shift in the distribution channel mix (buy-and-bill vs. pharmacy). Pharma companies should work with their HUBs and specialty pharmacy partners to plan for a timely and smooth transition of patients from a hospital pharmacy to a regular specialty pharmacy. For products that are purely buy-and-bill, pharma companies should evaluate if a specialty pharmacy channel should be activated to support home-infusion demand.
3. Extended and early refills: As a response to COVID-19, several payers and PBMs such as Anthem and BlueCross BlueShield have already relaxed some of their formulary and prior authorization requirements and are allowing extended 90-day supplies and early refills. Others, such as Express Scripts, have stated that they are monitoring the situation and will make appropriate adjustments as needed.
Pharma companies should proactively work with their HUBs and specialty pharmacies and analyze the shipment data to understand demand and patterns. This policy change can have a serious impact on drug availability, financial forecasts and even incentive compensation; therefore, manufacturers should plan to closely monitor the impact and be ready to make appropriate adjustments to their supply chain, inventory and forecasts.
4. Patient assistance programs: With some estimates predicting post-COVID-19 unemployment rates rising as high as 32% in the U.S. by the end of Q2, and the government deciding against opening up the Obamacare marketplace mid-year, manufacturer-sponsored financial assistance programs are likely to see increased utilization. Also, the utilization should be expected to remain at higher than normal levels as the economy will take longer to restore itself back to pre-COVID-19 levels.
Pharma manufacturers should reassess their patient assistance program design, eligibility and budgets for 2020. Manufacturers can also consider rolling out specific programs (such as bridge programs) that provide additional assistance for the duration of COVID-19.
Cancer and rare disease patients already have a lot to deal with, and COVID-19 puts them in a particularly vulnerable and stressful position. In this time of need, manufacturers can do their best by ensuring that patients have easy access to the necessary support for their emotional, logistical and educational needs.
For more ZS insights on the impact of COVID-19, visit zs.com/COVID19.