美国医疗服务： Specialty Pharmacy专题活动总结

U.S. Healthcare Services: A summary of our teach in on specialtypharmacy We held a teach-in on Specialty Pharmacy last Wednesdayto provide a detailedoverview of the specialty pharmacy industry, including its history, economics, andcompetitive dynamics. This note summarizes key takeaways from the webinar(see replayhere and slides here). Lance Wilkes+1 917 344 8501lance.wilkes@bernsteinsg.com Adam Chow+1 212 845 7820adam.chow@bernsteinsg.com What is specialty pharmacy -Specialty pharmacy differs from traditional retail pharmacybecause it focuses on high-cost, complex therapies, many of which are biologics.Although specialty medications account for only 3-4% of prescription volume, theyrepresent more than half of total drug spending and have been one of the fastest growingareas of the pharmaceutical market. Specialty drugs may be covered under either thepharmacy or medical benefit, with approximately 2/3 of spending occurring through thepharmacy benefit and 1/3 through the medical benefit, depending on how the therapy isadministered. Kevin Peterson+1 917 344 8358kevin.peterson@bernsteinsg.com Business models -Unlike PBMs, which manage drug benefits and negotiate rebates,specialty pharmacies generate revenue by dispensing medications and providing clinicalsupport, making them less exposed to regulatory and policy risk. Compared with retailpharmacies, specialty pharmacies are typically centralized distribution operations thatemphasize patient support services and are heavily involved with home delivery. Specialty pharmacy economics -Despite dispensing relatively few prescriptions,specialty pharmacies generate substantial revenue because specialty drugs are extremelyexpensive. Profitability is driven by factors such as scale, access to limited-distributiondrugs, biosimilar adoption, vertical integration, and payer relationships, with the largestplayers (CVS, Accredo, and Optum) dominating the market, though increasing regulatoryscrutiny could potentially lead to PBM and specialty pharmacy separation in the future. We will continue our Summer Teach In series with a session on Medicaid ManagedCare7/30 at 11am ET (Click here to register). This session will entail a detailed explorationof the managed Medicaid industry including its history, competitors, policy impacts, and thecurrent and future outlook. We will have an additional PBM Teach In on 8/20at 11am ET (Click here to register).This session will focus on the emerging transparent PBM model and look to the self-insuredemployer MCO model for examples of how that business operates. BERNSTEIN TICKER TABLE INVESTMENT IMPLICATIONS We rate AGL Market-Perform with a target price of $86, CNC Outperform with a target price of $68, CI Outperform with a targetprice of $381, CVS Outperform with a target price of $106, ELV Outperform with a target price of $488, HCA Market-Performwith a target price of $413, HUM Outperform with a target price of $425, Molina Outperform with a target price of $286, andUNH Outperform with a target price of $512. DETAILS There are several factors that differentiate specialty pharmacy from traditional retail pharmacy.Specialty medicationsare more likely to be biologics than small-molecule therapies and typically treat complex, chronic, or rare conditions. Thesedrugs are often high cost, prompting some PBMs to incorporate cost thresholds into their definitions of specialty medications.Although specialty medications account for only 3-4% of prescription volume, they represent more than half of totalprescription drug spending. Compared to retail pharmacies, specialty pharmacies allow more control over where drugs are dispensed, how the dispensingprocess is managed, and the promotion of adherence to make sure the drug is being used as prescribed. In addition, manyspecialty medications require special handling, storage, and administration. EXHIBIT 1:What is specialty pharmacy Specialty pharmacy has been one of the fastest-growing segments of the pharmaceutical market.Many newlylaunched therapies, particularly biologics, enter the market through specialty channels. As a result, specialty drug spending hasgrown significantly faster than traditional medications, with recent cost trends averaging approximately 9% annually comparedwith 2.5% for traditional drug therapies. Specialty medications may be covered under either the pharmacy benefit or the medical benefit, depending on how they areadministered. Pharmacy benefit specialty drugs are typically self-administered products, such as oral therapies and self-injectables, while medical benefit specialty drugs are generally administered by a healthcare professional in a physician office,infusion center, or hospital setting. The drivers of spending differ across these benefit categories. Within the pharmacy benefit, growth is primarily driven byincreased utilization as therapies gain broader adoption. Within the medical benefit, spending growth is driven more byincreases in unit cost. More