Adherence is Paramount in Era of Rising Specialty Drug Costs

Catamaran chief medical officer discusses various trends that will impact specialty medications into the future.

Catamaran chief medical officer discusses various trends that will impact specialty medications into the future.

With a robust pipeline, the development of innovative specialty drugs for chronic conditions had a significant impact on spending last year, which prompted payers to focus on monitoring and forecasting the pipeline, according to the Catamaran Corporation in its annual Informed Trends report.

Exclusive specialty arrangements for more consistent and streamlined management of specialty therapy and high touch patient support that promotes better adherence have become vital in the new era of increasing specialty drug costs. The formulary addition of specialty tiers for better pricing and incentives to encourage members to choose these preferred options are gaining prevalence in the marketplace to confront these high costs.

Meanwhile, the trend of specialty drug approvals outpacing traditional drug approvals is expected to continue into the future, as the specialty and biological pipeline currently comprises nearly 50% of pharmaceutical research and development activities.

To discuss many of the issues surrounding specialty drug development and trends, Specialty Pharmacy Times spoke with Sumit Dutta, MD, MBA, senior vice president and chief medical officer at Catamaran.

SPT: How do you think competition among effective new hepatitis C drugs will effect the high cost of these treatments over the next few years?

Dutta: In general, competition is a good thing as it allows for better negotiations, which we most recently saw in the hepatitis C market. As a result of industry competition, Catamaran was able to work with Gilead to introduce a new clinical outcomes-based program for breakthrough hepatitis C treatments that takes clinical results into account for overall treatment costs.

SPT: With the continuing growth of the specialty drug trend, how will the growth of these drugs continue into the immediate future?

Dutta: As innovative new hepatitis C treatments continue to demonstrate optimal viral response rates, the category will continue to garner comparable attention to 2014.

SPT: With the increase in the average cost of a specialty prescription, does Catamaran project this cost inflation to continue into the future or do you project the average cost will level off?

Dutta: We’re forecasting an overall pharmacy trend of 5.7 to 9.1% for 2015, with the potential to reach double-digit trend increases in the coming years. The compounding effect of price inflation on expensive specialty agents will continue to drive trend in the years to come — putting an increased focus on driving medication adherence to help avoid more costly health expenditures, such as hospitalizations, down the line. Additionally, as breakthrough treatments with improved clinical outcomes bring greater competition to the market, Catamaran will be able to better negotiate with pharma companies, ultimately leading to increased price control.

SPT: Do you project the cost of hepatitis C drugs to continue driving specialty spending?

Dutta: Catamaran expects the blockbuster hepatitis C treatments will peak in 2016, which will continue to drive trend. This makes it even more important that we create innovative approaches to help our clients mitigate these costs — such as our Hepatitis C Clinical Outcomes-Based Program, which ensures these high-cost therapies accomplish what they are designed to do.

SPT: Based on the current drug pipeline, what specialty conditions are poised for significant new treatments over the next year?

Dutta: The specialty/biologic pipeline is expansive, approaching 50% of pharmaceutical research and development activities — with breakthrough treatments for breast cancer, rheumatoid arthritis, hepatitis C and multiple sclerosis shaping the 2015 forecast. Additionally, the cancer drug pipeline is strong. Four of the five fastest-growing developments are cancer-related, including melanoma, chronic lymphocytic leukemia, non-small cell lung cancer, and non-Hodgkin’s lymphoma.

SPT: Please discuss some of the new strategies payers are adopting to manage the high cost of specialty drugs.

Dutta: Catamaran helps payers achieve the greatest value for their health care dollar by ensuring their plan manages drug costs while also promoting high quality care, ensures safe and effective medication therapy, leverages drugs to improve overall patient health, and helps patients get maximum value from their pharmacy benefit. Payers are increasingly open to adopting new strategies to address specialty marketplace trends. Through our BriovaRx specialty pharmacy, we are working together to promote better adherence and appropriate medication use through streamline management of specialty therapies and high-touch patient support. A tiered approach to specialty formularies will receive careful consideration for its potential to drive significant cost-savings while still achieving optimal health outcomes for patients.

SPT: How will new specialty tiers among payers impact the cost of specialty drugs?

Dutta: Adding specialty tiers to formularies will incentivize patients to choose clinically effective, lower-cost options — ultimately leading to great cost-savings overall.

SPT: Why did treatments for HIV/AIDS see a decline in utilization?

Dutta: We saw a dramatic 13.7% decrease in HIV/AIDS agents and associated comorbidity claims that usually accompany these particular patients, which can be attributed to a decrease in high-risk utilizers across the commercial book of business. At that same time, we saw an influx of HIV/AIDS patients through the Health Insurance Marketplace.

SPT: Please discuss the importance of adherence programs and how providers can initiate programs to boost adherence?

Dutta: Specialty medications accounted for 28% of total drug costs but only 1% of claims, bringing to light the need for closely managing patients who use these drugs to reach the best clinical outcome at the best value. For many specialty conditions, we offer management programs to provide patients with the personalized support they need to simplify the day-to-day management of their condition and get the best value from their therapy. For example, members going through the expensive new hepatitis C therapies through Catamaran’s BriovaRx specialty pharmacy program showed 9.1% better adherence results. The interactive approach encourages patients to stay adherent to their medications and advises them of the risks associated with skipping a refill, further preventing medical costs associated with additional treatment or hospitalizations.

SPT: Are there any particular emerging trends in specialty drug management that specialty pharmacists need to be aware of?

Dutta: The role of medicine will take on an ever-more-important role in the overall healthcare system. Innovation in pharma is driving the development of new drugs with greater promise for both managing and curing serious, chronic and prevalent disease states. The entire healthcare community will need to work together to ensure the best results, both clinically and economically — since the right prescription drug therapy has the potential to reduce the number of hospitalizations, ER visits, and other costly medical expenditures.