Specialty Pharmacy

While pharmaceuticals have always had a vital impact on patients’ outcomes and improved quality of life, they also have played a large role in the growing expenditures of healthcare. Increased spending on pharmaceuticals outpaced every other category of healthcare expenses throughout the 1990s. But in the past few years, managed care pharmacy executives have had a bit of relief, in part because of the increasing rate of generic utilization. However, it seems that newer, more complex drug therapies are in development, which means continued escalating cost concerns are always on the horizon.

Specialty pharmaceuticals is a fundamental case. The utilization of specialized, high-cost injectable and biotechnology drugs is increasing, with continued growth predicted well into 2010 and beyond. Though these therapies affect between 1-3% of patients, by 2008 they are projected to account for 26 percent of an average pharmacy budget. These new specialty pharmaceuticals have an average cost of $27,000 annually, with some costing up to $300,000 a year.

The dilemma is that these medications have an unprecedented positive impact on patients. For example, the drug Humira treats rheumatoid arthritis and can keep a person mobile and active, outside of a nursing home, by preventing joint damage and loss of function; additionally, by decreasing pain, a patient’s quality of life is enhanced. Other specialty medications of crucial importance include treatments for multiple sclerosis, hepatitis C, psoriasis, cancer, and a range of rare disorders. With these medications’ benefits far outweighing their costs, managed care pharmacy executives need solutions that work within their limited budgets while providing the best care.

Pharmacists understand this predicament first-hand: Their intent is to best manage  patients who take complex, intensive drugs, with the foundation of our business model being a focused dedication to superior patient care. The best model for specialty pharmacy is the one that allows access for the patient to trained professionals such as pharmacists and nurses. Taking these drugs is a highly emotional process for patients, so providing training and support for those who must inject their medication is key to outcomes and compliance.

The elements to a successful program, whether it be in mail or retail should include the following:

• Conduct utilization review and management
• Proactively identify and manage specialty cost drivers
• Identify opportunities for the use of treatment guidelines
• Evaluate actual clinical and therapeutic impact
• Assess compliance at provider and member levels
• Implement provider education programs
• Coordinate clinical support services
• Provide member support and education
• Measure outcomes

What does your Specialty Program include?