Payers' Priorities Revealed in the 2012 Managed Care Biologics and Injectables Index

Payers look to hepatitis C and do not see the value of credentialing bodies in specialty pharmacy, according to The Zitter Group's Fall 2012 Managed Care Biologics and Injectables Index.

Payers are still concerned with the same top 5 disease categories as they were in 2011, and they see competitive pricing as the most valuable service offered by specialty pharmacy providers, according to The Zitter Group’s Fall 2012 Managed Care Biologics and Injectables Index. The only difference within the top 5 disease categories is that hepatitis C is now the top priority over multiple sclerosis and rheumatoid arthritis.

The survey examined answers from 103 managed care organizations between October 12, 2012, and November 23, 2012. Among the key findings from the index:

• Payers are most concerned with medical and pharmacy costs per individual, and they say they expect the greatest growth in the prioritization of hemophilia FVIII agents over the next 12 months.
• Nearly 90% of payers noted that they handle the prior authorization process in-house and therefore do not utilize these services at a specialty pharmacy.

Notably, one-quarter of payers (26%) indicated that they have their own specialty pharmacy or have an ownership stake in one through their own company. Payers who own their own specialty pharmacies and those who outsource their specialty pharmacy services both said they do not find value in the credentialing of specialty pharmacists, and only 13% of payers said that they mandate the credentialing of pharmacists employed by their specialty pharmacies.