Research & Insights

Pharmacy and lab

Pharmacies and labs are simultaneously frontline providers and strategic businesses. We help them partner with stakeholders across the care ecosystem, prepare for emerging disruptive therapeutics and diagnostics, and understand the evolving cost control and benefit management environment.


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Specialty pharmaceuticals now make up more than 50% of pharmacy benefit spending in the United States. Here's what you need to know:

  • There is no standard definition for a specialty medication, but typically these medications cost more than $6,000 per year and may require special handling or monitoring for safety.
  • Some specialty medications are administered in a clinic, such as via an infusion or injection. Others, such as pills or self-injectables, are dispensed to the patient from a specialty pharmacy.
  • Health plans are increasingly controlling costs by placing restrictions on provider-administered specialty medications.

Lab tests are involved in approximately one-third of all patient encounters.

 

Only 10% of lab tests are considered specialized or genetic, but these tests are costly and complex. Both health systems and health plans are looking for partners to help them manage these tests.

 

Although there has been rapid growth in home testing digital startups, actual adoption will be slower than expected because providers, patients, and plans are all concerned about the quality of home testing.

Pharmacy benefit managers (PBMs) are often hidden from view, but they have a central role in selecting which drug a patient is prescribed and how much they pay for it. Here’s our 101-level explanation of PBMs.

PBMs are hired by health plans and employers to manage the processes and costs related to drugs dispensed by retail and specialty pharmacies.

We are keeping our eyes on eight categories of diagnostic and therapeutic innovation that promise to disrupt care as we know it:

  1. At-home diagnostics
  2. Biomarker testing
  3. Deep brain stimulation
  4. Digital therapeutics
  5. Liquid biopsies
  6. Pharmacogenomics
  7. Psychedelic-assisted therapy
  8. Ultra high-cost drugs
  1. Home infusion is forecasted to grow rapidly over the next five years. Here’s how stakeholders are shaping this trend:
  2. Patients have embraced home-based care.
  3. Health plans are instituting more site-of-care restrictions for hospital outpatient infusions to lower overall cost of care.
  4. Pharmaceutical manufacturers are creating new formulations of their infusion products that are safer and faster to administer.
  5. Private equity companies have invested millions of dollars into home infusion providers, hoping the high demand for infusion services will result in profits.

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