Specialty pharmacy management strategies continually updated

Costs for specialty pharmaceuticals continue to increase at double-digit rates. Therefore key stakeholders such as pharmacy benefit management (PBM) companies, health plans, specialty pharmacies, employers/groups, and physician specialists, are looking for ways to most efficiently manage these products for patients. A number of different programs and sources were discussed at the 22nd annual meeting of the Academy of Managed Care Pharmacy (AMCP) in San Diego. These include the Foundation for Managed Care Pharmacy (FMCP) Specialty Pharmacy Initiative, the EMD Serono Specialty Digest (6th edition), and the BMS Biotechnology Monitor & Survey.

The goals of the FMCP Specialty Pharmacy Initiative are to harmonize language, terminology and resources in specialty pharmacy and assess benefit design, service level specifics and care delivery methods using eight different stakeholders. Some findings highlighted in the report include: not enough data to benchmark specialty pharmacy service, fatigue from providers and patients related to obtaining specialty pharmacy coverage and payment, inconsistent specialty pharmacy distribution channels, anxiety and anticipation over new specialty drug pipelines, and confusion about benefit design (eg, medical vs pharmacy benefit) and approvals.

The EMD Serono Specialty Digest provides a comprehensive overview of specialty therapeutic management trends. Significant findings of this digest include integration of pharmacy and medical benefits and managing both oral and intravenous oncology therapies.  The top 5 therapeutic categories in the report are growth hormone treatment, rheumatoid arthritis, Crohn's Disease, multiple sclerosis, and hepatitis C.

Data collected in this year’s Digest support the fact that health plans are continually updating and improving their specialty pharmacy management strategies to optimize clinical outcomes for their members, according to Debbie Stern, RPh, vice president, Rxperts, a managed care consulting firm in Irvine, Calif., and editor of the EMD Serono Specialty Digest. ”In addition, payers are continuing to increase the cost share for members needing specialty drugs, which can result in decreased adherence to therapy if members can’t afford the drugs,” Stern said. “Benefit designs need to be developed that balance access, affordability, and appropriate use."

"There is so much emphasis from payers across the country imploring our industry to assist in the appropriate management of these expensive, but potentially life-changing medications. Managed care pharmacists need good information in order to develop the right benefit designs and utilize appropriate management tools to ensure the responsible use of these agents,” said Steven G. Avey, MS, RPh, vice president, managed care Partners Rx Management, a Scottsdale, Ariz.-based PBM company.

Avery, who serves as a Biotechnology Monitor & Survey editorial board member, presented a condensed version of the survey findings at AMCP. It evaluated numerous therapeutic categories, drug spend, use of protocols and guidelines for managing biologic utilization, and different benefit designs. Use of disease management programs and outcomes studies were also identified.

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