From Cholesterol to Hemophilia, Managing the Spectrum of Specialty Care and Costs


Aug 26, 2015




Brian Mischel, Clinical Director, Medicaid

Monalisa Mohanty, Senior Clinical Director

Health plans are increasingly challenged with managing the costs associated with specialty medications while providing the specialized care these patients require to ensure medication adherence.

Whether it’s expensive hemophilia products, or new oncology drugs in the pipeline, it is critical for plans to be able to provide the right patients access to the right medication at the best possible price with the highest level of care.Plans also need to take into consideration the new PCSK9 inhibitors – specialty drugs now being utilized in more common conditions like cholesterol – where the total annual cost burden of therapy for U.S. payers and patients is on a path to become the most costly therapy class this country has ever seen and could eventually grow to more than $100 billion each year, if not managed properly.

For managed Medicaid plans, it means flexible strategies tailored to address these novel and critical therapies. It also means pushing boundaries with advanced management for specialty medications, with decision support tools for providers and specialized patient care for members, will continue to become even more critical.

In this session, pharmacy experts Brian Mischel, Clinical Director – Medicaid, and Monalisa Mohanty, Senior Clinical Director – Specialty Solutions, will share best practices plans can employ to achieve the right balance of high touch care coupled with cost management.