Better Alignment With Consumer Drivers Needed in Health Care, Specialty Pharmacy

Albert Thigpen, president and CEO of the newly formed CastiaRx, discussed how health care and specialty pharmacy services are failing to keep up with the rapidly changing drivers of consumers and explained some areas that need to be addressed in order to reverse this trend.

During his presentation, “The Rise and Role of Consumerism in Specialty Pharmacy,” Mr Thigpen explained that consumers have recently acquired a lot of leverage due to changes in the health care space. Consumers are now paying more money, and therefore they are scrutinizing their health care choices more than ever before.

He explained that this shift is partially due to the increased popularity of high-deductible health plans over the last decade. Mr Thigpen cited data showing that the average member of a high-deductible health plan pays $1000 toward their deductible. He also noted that high deductible health plans have increased from 4% of the market share in 2006 to 28% in 2017. 

Another shift highlighted by Mr Thigpen is the recent evolution of consumer-based experiences across other industries. Retail consumerism has changed completely in the last decade, giving consumers a higher bar for how fast they want services delivered and how easy they want their purchasing experience to be.

Mr Thigpen highlighted six areas that drive consumer purchasing behaviors and how they can be improved in the health care industry. 

The first area highlighted by Mr Thigpen was pricing. He noted that 64% of purchasers make their decisions based solely on price. He said that programs, such as copay differentials and reimbursement pressure can be improved in the health care space to address this area. 

The second area that drives consumer’s purchasing decision, according to Mr Thigpen, is loyalty. However, he noted that consumers are only loyal to a certain point. He explained that loyalty is driven by convenience, and in a world where Amazon can deliver consumers almost any product overnight at a competitive price, specialty pharmacy pales in comparison. 

“What is the average turnaround time of a specialty drug?” he asked the audience. “By the time you get a referral in the door, 14 to 21 days, in some cases 30 if it’s a complicated prior authorization. Here in specialty pharmacy we are saying ‘you’re telling me I need this, I’m sick, and by the way I can’t get it for another 2 to 3 weeks.’”  

This leads to the third area highlighted by Mr Thigpen, fulfillment. Specialty pharmacy needs to improve on how fast it can deliver products and how easy they are for the consumer to get their hands on. 

The fourth area highlighted by Mr Thigpen was improvements in products and services. He said that when a consumer has a positive health care experience, they are often looking for other ways that provider, health system, or pharmacy can help them. He said the health care industry needs to harness this in order to improve. 

“What a disservice we have done as an industry to the specialty consumer today,” he said.
“Specialty pharmacy is defined by a set of drugs, and then mail order is a separate set of drugs. Here is the ironic thing: in specialty today, every patient that we see on average has an additional 2.5 comorbidities. What kind of disservice is that to a patient, that we’ll fill your MS drug but you have to go somewhere else for your depression drug.”

He explained that the fifth area is also defined by the disservice health care is doing to patients: digital engagement. He highlighted how fragmented the digital experience is for patients in health care, requiring multiple different apps for pharmacy, health insurance, providers, and more. 

The final area highlighted by Mr Thigpen was innovation. He explained that technology such as the Amazon Alexa and other voice assistants could be harnessed to give patients appointment reminders, drug reminders, and perform refill requests.

Mr Thigpen concluded by noting that while the health care industry is a difficult to course correct, it is that same mentality that drives further fragmentation and inefficiency. He pointed to other giant industries, such as music, travel, and banking, that have all undergone dramatic changes due to the demands of the consumer.

“Are we really listening to what the consumers are telling us?” he asked. “What are we doing to actually listen to the consumer and cater our services to meet their needs? My own personal opinion is that we have done a really poor job at it—and now is the time for it.”

—David Costill