Editor’s note: This story is based on discussions at Abarca Forward, a conference in San Juan, Puerto Rico, hosted by Abarca Health, a pharmacy benefit manager. MedCity News was invited to attend the event. Accommodations for the team were covered by Abarca. However, company officials had no input in editorial coverage. 

The healthcare industry is reaching a boiling point when it comes to the prescription drug space. Drug costs are continuing to increase, an issue that is worsening due to the hefty price tag and high demand for GLP-1s. And key players — including the Big Three pharmacy benefit managers (CVS Caremark, Express Scripts and Optum Rx) and drug manufacturers — are facing more scrutiny from the federal government.

At the Abarca Forward conference held in San Juan, Puerto Rico, the PBM Abarca Health gathered together health executives to discuss innovations in the prescription drug space. And in an interview at the conference, Abarca Chief Growth and Commercial Officer Javier Gonzalez shared the four trends that are top of mind for him.

1. Specialty drugs: Abarca is mainly focused on health plans, and one of the main concerns for this area is the evolution of specialty drug management, Gonzalez said. The industry is seeing slow adoption of biosimilars, but a potential rise in value-based care.

“We’re trying to see if we can transform the way that specialty pharmacy operates. … These are entities that manage very high-risk, high-cost drugs, and at some point, if we continue to push reimbursement down to them, how can we figure out how to continue to allow them to have the profits that they need in order to reinvest? … How do we figure out how to change that conversation and pay them more on the outcomes?” he said.

2. AI in healthcare: The company is following the “continued evolution” of AI in healthcare, and sees opportunities for using the technology to support payment, operations and decision-making, Gonzalez stated. He added that he thinks new pricing models for prescription drugs will come to the market because of the “amount of information that we’re gathering and being able to compute and project.”

3. Impact of obesity-related conditions: Over the next 10 years, Medicare is projecting that $4.1 trillion will be spent on obesity and related conditions, Gonzalez noted. GLP-1s have surpassed $50 billion in drug spend and are projected to be at $100 billion by 2030.

“These are all very, very strong trends that are concerning,” he said. “We have to think about, what can Abarca do? What can the healthcare industry do to try to solve that?”

4. Increased government regulations: There is increased scrutiny from the federal government over the PBM business model, particularly with the Big Three PBMs (CVS Caremark, Express Scripts and Optum Rx). The FTC has been investigating them, and several bills have been introduced targeting PBM practices. However, Abarca views this as an opportunity.

“What we’re seeing is that health plans are thinking about their existing models of their PBMs, and they’re looking for alternate solutions because they see the writing on the wall and they want to get ahead of all these regulations in order for them to be competitive,” Gonzalez said. “And so we see that as a tailwind because Abarca can provide some very effective, modular PBM solutions.”

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