In May, thousands of industry players descended on the Wynn in Las Vegas for Asembia’s annual Specialty Pharmacy Summit. The interactions were hot and it proved to be a great success, as it always is.
As such, I wanted to take a moment to highlight what we saw at this year’s Summit as it pertains to the patient services slice of pie…
Key Trends & Takeaways
Co-Pay Accumulator Programs
- Accumulator adjustment programs deny members credit for OOP expenses that are assigned by the health plan and funded by a drug manufacturer’s coupon program.
- Clients are continuing to seek guidance on what actions to take in response
- It’s recommended that you only help affected patients versus a total patient approach
- The states are acting but understand the limitations
- State laws only apply to plans inside/funded in the state, so we aren’t talking about a large patient population.
- At TrialCard, we define pharmacy fraud as the transmission of a claim, by a pharmacy, to one of our processors, where there is no intent to deliver product to a patient.
- More manufacturers are experiencing significant financial implications of missed fraud
- Action is required to ensure valuable reimbursement dollars are saved
- Remember that while pharmacy fraud is not widespread from a number of pharmacies perspective, those who “break bad” do not just dip their toe!
- Over the last six months, we have investigated 100+ pharmacies and blocked over half from the network.
Technology Driven by Consumerism
- eServices eliminate the need for traditional hub models, but they aren’t going away.
- Unique technology is available to identify patient needs, as well as increase engagement.
- We saw an expected technology entrant with Amazon acquiring PillPack, but the question to me remains…who is the next big player to enter and/or Amazon’s play?
Karaoke Machine + UBER = Sheer Genius!
- Honestly, we should have hired Martin on the spot…
I look forward to the Specialty Pharmacy Summit each year. It’s thrilling to have so many brilliant minds in one place looking to drive our industry forward.
The one thing I think we all know is that the remainder of 2019 and the first part of 2020 will be fast and furious from a regulatory, governmental, M/A, and new entrant perspective…so buckle up!
Until next year, when I have the thick cut bacon and bone-in ribeye from Del Fresco’s!
Richard Whittington, Vice President of Market Access Solutions
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