Technology, Trade, Tariffs Pose Challenges to Specialty Pharmacy
by Angela Maas
While issues such as affordability and accessibility may be long-time challenges within the specialty pharmacy industry, technology, potential tariffs and trade issues are adding to the headaches. Speakers during a recent HMP Global-sponsored webinar discussed these and other factors that need to be overcome to ensure these medications are able to realize their full potential.
The Oct. 24 webinar, titled “Rethinking Specialty Pharmacy in a Time of Disruption,” featured speakers who are members of the editorial advisory board for HMP Global’s First Report Managed Care resource.
Specialty pharmacies are facing several challenges, including affordability, accessibility and care coordination, maintained Lucille Accetta, R.Ph., senior vice president, chief pharmacy officer and head of CVS Specialty Operations at CVS Health. Having dedicated care teams specially trained in these medications that can help coordinate care throughout a person’s treatment journey is critical, she said, as is making sure that these teams can reach patients in underserved communities and rural areas.
Accetta noted that technology is key to supporting all stakeholders, from pharmacists to providers to patients. At CVS, more than 90% of patients have opted to use digital tools, “empowering patients to truly take control of their health care journey.”
Trade Tension, Tariffs Impact?
Other challenges facing specialty pharmacy include trade tensions and tariffs. When asked about their impact, Adam Colborn, associate vice president for congressional affairs at the Academy of Managed Care Pharmacy (AMCP), replied that it was “a great question,” but “the short answer is, I don’t know because I don’t think anyone really knows.”
The situation, he asserted, is “highly fluid” and changing daily, but, he added, other factors are in play as well.
For one, disagreements over whether to extend enhanced premium tax credits for marketplace plans have led to the government’s shutdown. And even if the subsidies are extended, “it probably is already too late to change” the 2026 rates, which go into effect this Saturday, Nov. 1.
Budgetary constraints from H.R. 1, the so-called One Big Beautiful Bill Act, will impact not only specialty pharmacies but also pharmacies overall with the hit to Medicaid, he declared. “And state governments are going to have to make some pretty serious decisions about manufacturers weighing what to do in response to” the new online direct-to-consumer pricing tool TrumpRx and the administration’s push for most-favored nation (MFN) pricing.
“There’s a lot going on, and it’s happening at a very quick pace,” said Colborn. “People are having to make decisions very quickly. So I don’t want to make any sort of hard and fast predictions about where trade and tariffs will end up. But I would say just sort of strap in and get ready for the roller coaster ride.”
Worries around the pharma supply chain have long plagued the industry, and talk of tariffs as high as 200% on not only raw materials but also finished drugs has only increased concerns. While legal challenges to the president’s authority to impose tariffs are ongoing, if they are implemented, shortages in some areas may follow.
However, pointed out Colborn, many promises from the administration “have yet to materialize,” such as the MFN model, proposed in May via an executive order “that has just been sitting at” the Office of Management and Budget. “There’s been some speculation that that’s going to sit there indefinitely as a threat to manufacturers more than something that they mean to truly implement.”
Will New Entities Help Ease Pricing Pressure?
Tariffs and pressures on the supply chain will prompt impacted entities to pass on those price increases to consumers, stated David Sand, M.D., chief medical officer at ZeOmega. “For many of these medications, there’s a great deal of price elasticity. Most folks don’t have a lot of discretion in the medications that they take and, unfortunately, will have to pay the burden of whatever is charged.”
According to Sand, more pharma companies are likely to negotiate with the administration over MFN status, and “we’re also starting to see some novel relationships for associations with folks like Mark Cuban and other direct-to-consumer opportunities to rein in perhaps some of these increased prices.”
But, he predicted, it remains unknown at this point whether value-based pricing will play a role. Most of the current arrangements involve refunds, but it’s challenging for most health plans’ chief financial officers to “rationaliz[e] why they should either lose a refund or have to pay back a refund to…a company when their medication does what they say it’s supposed to do.”
Specialty biosimilars should have helped to navigate the tension between high drug costs and limited access, but what those drugs “taught us is that our market is broken,” maintained Alison Lum, Pharm.D., vice president of healthcare quality and affordability at Blue Shield of California. With plans choosing to cover a biosimilar that’s not interchangeable or only a product with a certain national drug code, pharmacists have been challenged “to know what to dispense or to have stock in hand.”
So beyond dealing with shortages or distribution issues, “we have to make sure that we have the information…to make sure that our patients have access to the right medication at the right time that’s covered and affordable to them,” she explained. “I’m not sure that our technology is keeping up.”