Opportunity and Challenges in Treating Neurologic Conditions

The American Journal of Pharmacy Benefits, February 2010, Volume 2, Issue 1

This issue of The American Journal of Pharmacy Benefts includes several articles about neurologic conditions and the medications used to treat them. We chose to focus on this area for 2 reasons.

This issue of The American Journal of Pharmacy Benefts includes several articles about neurologic conditions and the medications used to treat them. We chose to focus on this area for 2 reasons.

First, as we all know, the population of the United States is aging. Therefore, we are seeing an increased incidence of the many neurologic conditions that are more common in older individuals. Neuromuscular conditions have a far-reaching impact. They can affect not only healthcare costs but also workplace productivity and quality of life.

Second, more medications are available to treat these conditions. Scientists in pharmaceutical research and development laboratories are working on treatments for several conditions, such as multiple sclerosis, Parkinson’s disease, and Alzheimer’s disease. Treatments for neurologic disease also will be the subject of research in the developing feld of pharmacogenomics. Examination of the pipeline for new medications over the next several years shows that this class of drugs represents an area of great exploration and opportunity.

The 2 issues above-more patients with neurologic conditions and more medications to treat them-creates a scenario that has healthcare payers, health insurance companies, employers, and governmental entities evaluating how to make sure that the medications are used appropriately. It will be necessary to use all the tools available within the pharmacy beneft to address the challenges associated with these new agents. Programs ensuring that these medications are used for the right patients, under the right conditions, and at the right times will be necessary. These programs will most likely include a combination of provider-based screening, prior authorization, and ongoing follow-up.

Both payers and healthcare consumers are struggling to identify the appropriate ways to pay for these often- expensive medications. Most are considered specialty medications, the cost of which is becoming an increasingly signifcant percentage of the medication cost trend. According to CVS Caremark’s annual drug report, the specialty drug trend for 2008 was 12%, up from 9.9% in 2007.

Many medications used for neurologic conditions can cost hundreds, if not thousands, of dollars each month. Some pharmacy beneft managers and insurance companies have placed them in their own tiers; others have placed them in a separate beneft altogether. Traditional cost-share methodologies do not work with most of these medications. Flat copayments often place a signifcant cost burden on the payer, whereas coinsurance can make a medication unaffordable for a patient. The issue of cost will require thoughtful consideration, continued experimentation, and analysis. We welcome submission of papers on this subject, so we can learn from each other as we seek answers and try solutions.