Ray Tancredi, RPh, MBA, Vice President Specialty Pharmacy Development, Walgreens; Cheryl Allen, BS Pharm, MBA, Vice President, Industry Relations, Diplomat Pharmacy Inc.; Nicholas Karalis, RPh, Elwyn Pharmacy Group; Stacey Ness, PharmD, RPh*, Director, Specialty Clinical Services, Managed Healthcare Associates; Renee Rayburg, RPh, Senior Director, Clinical Consulting, Artemetrx
Domestic spending on specialty medications is projected to increase by 67% in 2015, which will lead to increased out-of-pocket spending for patients who will increasingly need to seek outside funding sources to pay for these treatments, the panelists agreed. With this increased rise in costs, Allen noted, the use of prior authorization will also grow.
Rayburg shared several ways payers can apply the prior authorization process to measure and evaluate appropriate use of medications. Prior authorization however, should not be seen as a vehicle to setting up barriers. Prior authorization should be used to identify the right patients to receive the right drug for the right duration, she concludes.
*The views expressed are those of the individual alone and not of Managed Health Care Associates, Inc.