Finsights Blog

The Best Laid Plans

As a newly-minted consultant, I came of age professionally during the healthcare industry’s transition from primary care to the specialty model. This distinction has given me front row seats to the death of the old model and the many growing pains of the new. Network design was a “set it and forget it” type of exercise — 3PL to full-line wholesale to retail — without much thought required.  As for the data, well the only thing that really mattered came from IMS or WK.  It was truly a simpler time.

Today network design can, and often does, make or break your brand. Channel (the partners, processes and economics) decisions have derailed brands (PCSK9’s) with amazing science and elevated others (Spinraza) with antagonistic reimbursement constructs. Data is about so much more than market share or incentive compensation. It underpins the living eco-system that drives a brand’s clinical and commercial success by providing visibility to patient/caregiver and provider/staff. How you piece together the longitudinal journey drives so much more than reporting; it’s about insights, experience, outcomes and adherence.

At the center of these designs, we can usually find the role of the specialty pharmacy. As health care providers, call center staffing, reimbursement specialists, and data suppliers, pharma asks these organizations to wear so many hats. We also expect them to excel in an environment where margins are so thin that the line between “lights on” and “lights off” is a dispense to dispense determination.  How the specialty pharmacy of today and tomorrow will be able to navigate the current landscape to achieve service excellence is one of the more interesting, and critical, questions being asked in the life sciences industry today.  That is what is driving me to attend CBI’s 4th Annual Specialty Pharmacy Network Design conference this week in Washington, DC.

While there, I hope to find interesting perspectives on the following questions:

  • What is the role of specialty pharmacy as we transition from specialty to gene-based therapies?
  • How does specialty pharmacy alignment impact a manufacturer’s network design?
  • Where are the pain points for specialty pharmacies in supporting access and reimbursement?
  • When does the IDN-SP model rise up? Can it achieve a critical mass?
  • Who is best situated to balance access, value and cost?

After the big picture Specialty Pharmacy view at the Asembia Specialty Summit, it’s time to get focused back in on the mechanics that make it all work. No launch takes place without some hiccups. Few claims go unchallenged. The model we are learning today has a shelf life and change can sneak up on the unprepared or complacent.

I’m looking forward to seeing how some of our unsung heroes are viewing the challenges and opportunities the manufacturing community is facing when making channel design decisions.

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