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.

Pharmacy Fraud

  • 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

For more information about TrialCard’s hub services, please contact Scott Dulitz, Chief Strategy Officer, at scott.dulitz@trialcard.com or e-mail sales@trialcard.com.

You may also visit TrialCard’s Resources Library to view its newest video, Emerging Market Trends Shape Hub/Market Access Services.