Specialty Drug Costs - Tim Wentworth | Express Scripts

Dec 26, 2012
Specialty medication costs continue to rise, and 58% of plan sponsors cite it as their biggest concern. Express Scripts proposes a comprehensive solution.

Earlier this year, Express Scripts released its 9 Trends Report, a national study polling 318 plan managers on prescription-drug-management trends. No. 7 on the list of trends was developing new ways to comprehensively manage specialty medication spend, with 58% of large plan sponsors citing rising specialty costs as their greatest concern. With year-to-date spending on specialty medications up 22.6% in 2012, there is great cause for that concern.

Currently, about half of all specialty medication spend is still adjudicated under the medical benefit, where payers have little insight into how patients are using these expensive medications and few opportunities to manage their use. But more and more, payers are applying tried-and-true therapy-management protocols to mitigate costs, avert waste and improve care.

Specialty Medication Management Strategies

To manage spend and provide a clear view of patient utilization, payers are relying on pharmacy benefit managers (PBMs) that provide comprehensive specialty medication services. Express Scripts is one such PBM.

With comprehensive management, Express Scripts can identify and manage trends before they become too costly. And working with us, plan sponsors can identify clinical management and engagement opportunities at the patient level, which is important when you consider that one patient alone using one specialty medication can cost tens of thousands of dollars.

Whether moving specialty claims adjudication to the pharmacy benefit or integrating core PBM protocols into the medical benefit, payers are using every tool in their arsenal to reduce waste and improve patient outcomes.

Strategies To Control Specialty Drug Trend

While doing all the above, it is essential to increase medication adherence. Adherence leads to better quality of life, lower absenteeism, improved outcomes and decreased medical spend. Specialty pharmacies have proven to help patients stay more adherent, with programs that provide counseling, education and support from specially trained nurses and pharmacists.

Payers will have to carefully manage specialty-medication use to ensure these expensive medications are used most efficiently and effectively. The good news is we have the tools in place to make a difference.

Click here to read the full report: 9 Leading Trends in Rx Plan Management.

Author Bio

Tim Wentworth
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