One pioneering company is hoping to solve what has become a Catch-22 for biologics makers: As physicians receive fewer financial incentives to administer infusion and injectable products in their offices, patients are forced to seek treatment in costlier, less convenient hospital or home settings.
The privately funded Active Care Network, after raising $5.3 million, has put together a group of 1,400 infusion clinics to deliver these drugs to patients. It negotiates discounts with specialty pharmacies, and its clinics offer evening and weekend hours--with a goal of increasing patient compliance by making biologics easier and cheaper to receive.
The company's debut in April also speaks to the greater price pressures that payers are facing. Specialty drugs, many of them biologics, are enjoying double-digit growth in major markets, according to IMS Health. And without a clear regulatory pathway for follow-on proteins--at least in the United States and at least until Congress moves draft legislation to the floor--these therapies are sheltered from patent challenges.
As a result, payers are resisting the traditional method of "buy and bill," by which physicians purchase biologics, administer them in-office, and charge health plans an inflated cost. Despite physician balking, plans increasingly prefer to negotiate with specialty pharmacies directly, leaving patients to travel to hospitals or hire home-health aids for administration of their treatment.
"Plans have really pulled back because of the sheer number of biologics hitting the market," said ACN founder, president, and CEO Judi Grupp, who previously led the Consumer Health Coalition, which advocates for public health insurance. But "when the plans put these policies in place, they didn't really think about the downstream impact. [They've created] a very fragmented industry."
Grupp pointed to Johnson & Johnson's Remicade (infliximab), a Crohn's disease drug, as the "buy-and-bill poster child." In the old days, about half of physicians choose to do infusions; now that number has dropped to 25 percent. "It really impacted their bottom line in a big way," she said. ACN is also hoping to function as a clearinghouse for post-marketing patient-outcomes data. According to the network, it has already signed up a number of "heavyweight biotech companies," but their names have not been publicly disclosed.
The clinics will also provide educational materials to patients, and help clinicians navigate through the complexities of administering biologics--even as their labels change. A proposed black box on Genentech asthma drug Xolair (omalizumab), for instance, would require health practitioners to monitor patients for two hours in case of an adverse reaction.
"Everyone focuses on the drug cost, but the drug cost is only [part of] the actual cost of therapy," Grupp said.