So, How Did It Go in Chicago? A Recap

If you weren’t able to join us in Chicago at our first Specialty Rx Forum, you missed an amazing opportunity to hear from a relevant and unique lineup of speakers. The overall goal of the event was to provide a 360-degree view of the specialty pharmacy landscape.

Increases in both utilization and cost of these medications are causing alarm to all key healthcare stakeholders. As a result, PBMI brought together speakers from all sides of the issue including highly-influential decision makers and C-suite leaders from three national employers, two leading PBMs, a pharmaceutical manufacturer focusing on biologics, a consultant in the pharmaceutical manufacturing space, and a specialty pharmacy.

Our intent was to keep the meeting smaller than our national conference (approximately 50 attendees), however attendance at the meeting far exceeded our expectations with nearly 100 registrations! Attendees included a variety of industry experts including employers, union groups, health plans, PBMs, drug manufacturers, consultants, specialty pharmacies, and financial analysts. Judging from the energy in the room, it was clear that folks were there to get the inside scoop. But don’t take our word for it, check out what attendees had to say.

“…Awesome Program!”

“Very nice selection of different perspectives on the specialty space. Great information.”

“Nice mix of subjects with excellent speakers. Topics were spot on. Excellent Meeting. Thanks!”

“Thank you for the great forum yesterday. I thought it had a lot of rich info and was one of the best most candid events I’ve been to in recent memory. Great Job!”

“Enjoyed different background of folks I got to speak with at lunch.”

Each perspective was unique and relevant…”

So, let’s do a quick recap of the presentations…

Evolution of the Specialty Pharmacy Landscape and Beyond

The meeting kicked off with an opening presentation from the founder of Blue Fin Group, a consultant in the pharmaceutical manufacturer industry. He kicked off his presentation with some staggering stats related to healthcare.

  • Median wage in 2016 was roughly $56k. Median cost of healthcare was $18k. In the next 15 years, it is expected the cost of providing healthcare will exceed wages.
  • In 2016, the average cost of a Specialty Drug became greater than the median household income.

There’s no doubt that changes have to be made to control the spiraling costs of specialty, but they must be made carefully as the impact will be felt across the pharmacy care continuum.  He used the analogy of a squeezed balloon. A one size model approach does not fit all. Healthcare stakeholders were challenged to think 15-20 years ahead to develop new innovative models. And to be sure that they’re balanced for each of the players, and that revenue and rebates are maintained. He isn’t a fan of a single payer strategy, but challenged the audience that if we don’t act, it could happen.

Challenges Employers Face (Employer Roundtable)

Following the opening speaker was our employer roundtable panel.  Benefit leaders from Boeing, Duke Energy, and Southwest Airlines representing a combination of nearly 700,000 covered lives, talked about issues important to them as they try to provide valued drug benefits amidst rapidly rising specialty trend. Their strategies to manage costs were diverse. Some key points included: all employers utilize some form of formulary exclusions; sensitivity to member noise regarding exclusions was significant to one employer compared to the others; copay cards were not that popular although one employer was supportive. While the needs of each employer were different, they all are concerned about the rising costs of specialty and the need to find ways to manage them that not only benefit the member’s health outcomes, but also make providing the care affordable to the member and also to the plan.

Navigating the Complexity of Cancer

The Chief Medical Officer from OptumRx presented on the second most common cause of death in U.S. – cancer. He articulated the fact that cancer is complex and comprised of potentially hundreds of diseases with a growing list of useful management strategies. Eighty-eight billion dollars is spent on this disease state alone. With the many factors driving utilization and costs (i.e., new products, longer survival rates, and disease prevalence), these costs are expected to continue to rise. To help manage these costs, in addition to prior authorization, employers should also consider split-fills, site of care optimization, and infusion networks.

Specialty Outlook: Pharma Perspective

The afternoon presentations started with a talk from a medical affairs executive from AbbVie, representing the pharmaceutical manufacturer perspective. Although the drug development process can be lengthy, costly, and include risk of failure, there are rewards: potential for improved quality of life, increased survival rates, overall better care and treatment for patients living with chronic diseases. The speaker shared an eye-opening statistic of the survival rate of children under the age of 15 with cancer. Over a period of 30 years the survival rate increased from 58% in 1975 to 81% in 2005. There is currently specialty drug development in immunology (e.g., psoriasis, Crohn’s disease, and rheumatoid arthritis) and oncology (e.g., chronic lymphocytic leukemia and small cell lung cancer).

Building Partnerships with Customers in Specialty Pharmacy

The Chief Pharmacy and Growth Officer from Walgreens Specialty touched on several topics from a specialty pharmacy perspective. It was interesting to learn that today there are 663 specialty drugs on the market, compared to less than 30 in the early 1990s. Looking ahead sixty to seventy-five percent of the drug pipeline will include drugs available only by limited distribution. Specialty pharmacy management presents challenges to everyone involved (patients, caregivers, providers, pharma, payers, and pharmacies) but we have to always remember that a patient living with a potentially life-threatening condition is part of the equation. There is a silver lining for managing the specialty pipeline: biosimilars,  big data, and new technologies.

Value-Based Pharmacy Management

The day ended with a great presentation from the Chief Medical Officer of CVS Health. He started the presentation with the sensitive topic of assigning a value to a life. He pointed out that many countries are using a quality-adjusted life year (QALY) matrix to score drugs, and many aren’t afraid to set a maximum price. However in the US, there is no consensus.  The speaker then provided an overview of value-based contracting strategies and shared three approaches that can be used: indication based (pricing/rebates aligned on drug effectiveness) outcomes-based (costs are aligned with the drug’s effectiveness), and finally cost-cap based (cost threshold established based on expected drug utilization). The best approach will depend upon the drug class and also therapy for a given condition.


Thanks to all that attended our inaugural PBMI Specialty Rx Forum. While many different perspectives were addressed, a couple key themes came out of the forum.
  1. Growing concerns exist across all stakeholders about the cost of specialty medications and who will be paying the bill.
  2. Better collaboration is necessary within the industry to evolve the business model and continue to meet the needs of the plan sponsor and the patient taking the specialty medication.

A very special thank you again to our sponsors!


As you know, this topic is dynamic and more discussion is needed. That’s why PBMI will continue hosting an annual Specialty Rx Forum again bringing together all stakeholders to continue the dialogue. Watch for a Save the Date in the coming weeks!

Stay in touch with PBMI and keep a close look out for future meeting details. If you’re not on our email distribution list, email to get added today.