Walgreens study finds results from pharmacy, specialty clinic collaboration
A recent Walgreens Center for Health and Wellbeing Research study assessed a collaboration between Piedmont Healthcare’s Hepatitis C specialty clinic and a Walgreens local specialty pharmacy and showed that a high proportion (94%) of Hepatitis C patients who were prescribed direct-acting antiretrovirals were able to achieve the primary outcome goal, sustained virologic response, even though many patients had advanced liver disease, previous treatment failure or previous liver transplants.
“Collaboration between pharmacists and providers is key to optimizing patients’ response to treatment,” stated Shauna Markes-Wilson, study author and local specialty pharmacist for Walgreens, a Deerfield, Ill.-based retail pharmacy operator. “Pharmacists provide high-touch support to overcome treatment challenges such as insurance prior-authorization and high copays. We ensure patient safety through drug interaction screening and patient education,” she said. “We communicate regularly to ensure that patients are adherent to their care plans and address any side effects, while keeping our providers in the loop.”
“Our providers and nursing staff at Piedmont Transplant had known that a collaborative approach with the Walgreens specialty pharmacy was improving access to expensive but highly curative hepatitis C medications, but we had never examined the data to quantify the benefits,” added Lance Stein, hepatologist, of the Piedmont Transplant Institute. “By combining our patient level data we now can quantify this collaboration’s benefits in expediting access to medications, lowering costs and still achieve the high rates of cure seen in DAA clinical trials.”
The descriptive, retrospective study, which published in the Journal of the American Pharmacists Association, used a joint clinical and pharmacy database of patients who were prescribed DAAs. Outcomes assessed included time-to-therapy, SVR, insurance appeals and copay assistance amount.
In addition, Hepatitis C patients managed jointly by this clinic-pharmacy collaboration had a shorter average prescribed time-to-therapy and lower copays compared to other published studies. After insurance appeals and financial assistance, patient copays were reduced to less than $20 per month for the majority of patients.
Walgreens has nearly 100 Hepatitis C specialized pharmacies across the country where trained pharmacists and pharmacy staff collaborate with Hepatitis C medical providers to ensure timely and affordable access to potentially life-saving treatment, the company reported.
Perrigo launches 2 generics
Perrigo has introduced two products, a generic of Mycolog II Cream (nystatin and triamcinolone acetonide cream, 1 mg/gram) and the Exalgo (hydromorphone HCl) extended-release tablets.
The Dublin, Ireland-based company’s Mycolog II Cream generic is indicated to treat cutaneous candidiasis. The drug had annual generics sales of $81 million for the 12 months ended September 2017, according to IQVIA data.
Perrigo’s Exalgo generic will be available in 32-mg dosage strength, and is indicated to treat severe pain in opioid-tolerant patients who require around-the-clock pain relief over an extended period of time. The drug had brand and generic U.S. sales of $32 million for the 12 months ended September 2017, according to IQVIA data.
"This launch is another example of the team's hard work in advancing our new product pipeline,” Perrigo executive vice president and president Rx pharmaceuticals John Wesolowski said. “This commitment is driving value for patients by delivering generic products in important treatment categories at more affordable prices.”
Cowen assesses Amazon’s Rx potential, marks RAD as prime acquisition target
As Amazon appears to be making moves to get into the pharmacy business — including the May hiring a senior manager of pharmacy benefits in May and the October acquisition of wholesale pharmacy licenses in 12 states in October — the question among industry players has been what form the online giant’s foray would take.
New York-based equity research firm Cowen has sized up the threat Amazon poses to the industry, and while its entry would not be as disruptive as some might think, there are still opportunities for Amazon in the pharmacy business, and Cowen suggests that some potential moves would still have a big impact — particularly through an acquisition of the Camp Hill, Pa-based Rite Aid.
“In one sense, we can view the entry of Amazon into the pharmacy market as another large chain store, or that of another mail pharmacy competitor,” the report says. “In this regard, we can see from our market model, depending on AMZN’s ability to get into retail and mail networks, there is a range of outcomes, but none suggesting retailers like CVS and WBA will be out of business.
According to data from IQVIA, Cowen notes that Amazon’s potential market size stands at roughly $203 billion in 2018, or about 43% of the U.S. prescription drug market and 62% of the American retail and mail pharmacy markets in 2018. It also doubts that Amazon would enter the specialty space, given the small patient population and accompanying services that accompany specialty drugs.
Cowen’s bull case for Amazon’s pharmacy ambitions projects the potential for it to seize a roughly 1% market share in 20189, growing to a 4% market share by 2023. This projection includes distribution through two-day delivery service Prime Now, same-day delivery service Prime Now and the company’s Whole Foods brick-and-mortar blueprint.
But a potential kicker could be Amazon acquiring Rite Aid, which would offer the company increased retail footprint. It also would bring Amazon state pharmacy licenses, infrastructure that has already cleared regulatory hurdles, potential generic sourcing options, access to retail network reimbursement contracts and $13 billion in drug spend and a small pharmacy benefits manager in the form of Rite Aid’s EnvisionRx that would open the door to mail-order, Cowen said.
“If Amazon were to launch Pharmacy in Whole Foods, on Prime and Prime Now, an acquisition of Rite Aid would accelerate market share gains and other positive benefits,” the report says noting that it wouldn’t be without its potential setbacks. “The main downside to acquiring RAD is that AMZN would inherit over 2,500 underperforming stores relative to its larger drug retail peers, which would need to be addressed.”
Even absent the challenges that the Rite Aid acquisition would bring, Cowen said that Amazon faces some headwinds to pharmacy — and that’s assuming that Amazon makes a big enough splash in the market to challenge existing supply chain players. In addition to the complexity that navigating payers and physicians would bring, Cowen highlights potential difficulty finding access to retail and mail networks, a limited sourcing scale initially and the continued integration of pharmacy into the larger care continuum.
The increased role traditional pharmacy retailers are playing in the healthcare space — particularly with regard to care and diagnostics testing increasingly provided through retail clinics — is one of protections against the Amazon threat that Cowen identifies. Additionally, the report suggests that further vertical integration in the name of care coordination and volume control could help insulate retailers — it highlights CVS Health’s rumored Aetna acquisition as a prime example. This is something that the specialty space is moving into, with Diplomat Pharmacy acquiring two PBMs in November — and Cowen identifies Diplomat as a potential takeout target for Amazon.
Ultimately, Cowen emphasizes the impact Amazon has on the established market will not be as big as initially expected, but that 67% of Prime users saying they would use Amazon pharmacy services could spur the e-retailer to take the plunge — forcing the established drug retailers to adapt.
“On a relative basis, we view the drug retailers (CVS and WBA) as facing the greatest risk, though at this point mostly from negative sentiment versus actual share loss,” the report says. “Even if AMZN were to enter, the long-term impact to shares is impossible to predict, given potential M&A and additional services the drug retailers could add that would transform their business models to something possibly wholly different.”