Episode 11: Management of High Cost Medications


Ray Tancredi, RPh, MBA, CSP, vice president of specialty pharmacy development at Walgreens; Cheryl Allen, BS Pharm, MBA, vice president of business development and industry relations for Diplomat Pharmacy; Nicholas Karalis, RPh, of Elwyn Pharmacy Group; Stacey Ness, PharmD, RPh, CSP, MSCS, AAHIVP, director of specialty clinical services for Managed Healthcare Associates*; and Renee Rayburg, RPh, senior director of clinical consulting at Artemetrx, discuss how to manage the high costs of specialty medications currently flooding the market.

Prior authorization is a utilization management tool payors can use to control spending, Rayberg said, as well as ensuring a proper diagnosis and preventing off-label use of medication. Allen explained in detail how split-fill programs can benefit payors, not only by preventing the waste of high-cost medications, but also because it means there will be more frequent live touch points to follow up with the patient. Adequately educating the patient about how a split-fill program works can also be beneficial, Ness added.

This split-fill strategy can also help keep medication costs at long-term care facilities down, Karalis said. In addition, nonbiased programs that do not base formulary decisions on reimbursement challenges and instead focus just on the appropriate patient care will ultimately produce the best outcomes, he concluded.

*The views expressed are those of the individual alone and not of Managed Health Care Associates, Inc.

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