Combatting Pharma Prices with a High-Touch Pharmacy Service Model

The Oregon Division of Financial Regulation published a list of the top 25 most-expensive prescription drugs in Oregon this week.

These are the drugs that “contribute the most to annual spending by health insurance companies,” according to OregonLive.com

According to Oregon.gov, Oregon’s Prescription Drug Price Transparency Program requires health insurance companies to report on prescription drugs in Oregon. Health insurance companies reported the 25 most prescribed drugs, the 25 most costly prescription drugs, and the 25 prescription drugs which caused the biggest increases in yearly health plan spending in 2018.

Related: Drug Prices, Shortages Remain Problem

The five costliest drugs for healthcare insurance companies are:

• Humira (adalimumab, Abbvie),

• Enbrel (etanercept, Amgen)

• Tecfidera (dimethyl fumarate, Biogen)

• Truvada (emtricitabine and tenofovir disoproxil fumarate, Gilead)

• Stelara (ustekinumab, Janssen Biotech/J&J)

“The cost of these newer therapies have garnered quite a bit of attention over the past several years. These drugs were approved on the premise that they provide clinical benefit for patients with serious and chronic conditions and work best when used appropriately and consistently,” says Jerry Buller, chief pharmacy officer at Trellis Rx, a health system specialty pharmacy service partner.

The high-touch specialty pharmacy service model employed by Legacy Health in Portland is an example of a health system initiative to improve adherence to these medications, which can enhance clinical outcomes and prevent disease progression (e.g., stop progression of HCV to liver cancer) or unnecessary medical events (e.g., surgery), according to Buller.

“The embedded specialty pharmacy model also serves to elevate the role of pharmacy on care teams to ensure these high-cost medications are being used appropriately and effectively,” he says.