How to Cut Specialty Rx Spend Increases in Half

Mar 7, 2013
Express Scripts study shows tightly managed health plans with multiple utilization management programs had lower specialty drug spend, increased adherence.

We all want healthier outcomes. Healthier financial outcomes that lower costs, reduce waste and make healthcare more affordable. More importantly, we want healthier clinical outcomes that provide greater patient safety and more effective care.

Bad Health Decisions Drive Up Costs

Unfortunately something is getting in the way. Bad decisions. The fact is bad health decisions are killing us. Bad drug decisions, bad pharmacy decisions and bad health decisions are driving up costs and leading to bad health outcomes. This is especially true in specialty pharmacy where serious, often life threatening conditions, are treated with complex and costly medications. This has led to a specialty drug trend that has grown by double-digit rates over the past six years and for 2012 increased 18.4%. It’s important to note that this growth represents just the pharmacy spending that occurs only in the pharmacy benefit. Approximately half (47%) of all specialty drug spend is billed through the medical benefit.

But it doesn’t have to be this way. Express Scripts recently did a study that was presented at the National Business Group on Health’s (NBGH) Business Health Agenda 2013 in Washington, D.C.

Tightly Managed Specialty Benefits Increase Savings, Adherence

Express Scripts researchers analyzed the specialty drug spending of 60 employer clients who are members of the NBGH, representing more than five million Americans with pharmacy benefits. The employers were categorized into one of three groups based on the type of cost management programs adopted:

  • Unmanaged – employers whose health plan members could obtain their specialty medications from any pharmacy and did not use any specialty utilization management programs.
  • Somewhat managed – employers whose health plan members used a specialty pharmacy exclusively and one specialty utilization management program.
  • Tightly managed – consisting of employers whose health plan members used a specialty pharmacy exclusively combined with multiple specialty utilization management programs.

Employers classified as unmanaged experienced an annual average increase in specialty drug spending per member per year of 27.8%. However, employers classified as tightly managed saw an annual increase in specialty drug spending per member per year of 13.6%, half that of the unmanaged group and nearly one-third lower than the average annual projected specialty drug trend. In addition, tightly managed programs saw higher average member adherence rates in top therapy classes, such as multiple sclerosis and oncology.

Better Decisions Reduce Waste

Clearly, clients who are making the better decision to tightly manage their specialty drug plans are saving tens of millions of dollars compared to those who are unmanaged. That’s money left on the table based on decisions being made.

Express Scripts, combining innovation from subsidiaries CuraScript and Accredo specialty pharmacies, is applying Health Decision ScienceSM to enable cost-effective, clinically appropriate health decisions that deliver improved patient care while reducing waste.

Through Health Decision Science, Express Scripts is combining behavioral science with the science behind clinical specialties and actionable data to create an environment where the best health decisions become the easier decision to make for patients, caregivers and health providers.

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