Prime's 7 Steps to Manage Specialty Drugs

Employers and health plans can begin to take control of these specialty drug costs by following 7 steps outlined in a new report released today by Prime.

Rising costs and increased use of specialty drugs are placing a greater burden on people, their employers and their health plans. In fact, spending on high-cost specialty drugs used to treat complex diseases such as cancer increased more than 19% among members of pharmacy benefit manager (PBM) Prime Therapeutics LLC (Prime) in 2012. That increase differs greatly from Prime's 0.9% drop in traditional (all non-specialty) drug spending in 2012. But the good news is employers and health plans can begin to take control of these specialty drug costs by following 7 steps outlined in a new report released today by Prime. The report, "Specialty: Today & Tomorrow," highlights Prime's specialty drug trend over the past year and recommends strategies that high-performing plans use to manage the steady rise in these costs.

"With the rising use of specialty drugs the days of 1% to 2% increases in annual drug spend are nearing an end," said Peter Wickersham, Prime's senior vice president of cost of care. "We are clearly entering a time of higher costs and plan sponsors who act now will be in the best position to assure quality care for their members while managing these high costs."

The 7 steps to success outlined in the report include:

  • Bridge the benefit divide: use combined pharmacy and medical benefit data to see the full scope of specialty spending and seek solutions.
  • Focus on the biggest issues: use combined data to target the most urgent issues and focus on the areas that can provide the greatest return on investment.
  • Narrow the specialty network: use cost-effective distribution channels and limit the number of distributors to secure lower prices.
  • Embrace a management mindset: make sure the right specialty drugs are used properly by those who will benefit the most.
  • Promote preferred drug use: build plans that encourage desired behaviors.
  • Protect members from high costs: limit members' out-of-pocket costs and use available tools to reduce the burden on highly vulnerable members.
  • Pick the right partner: select a trusted advisor with comprehensive capabilities and deep connections to help anticipate and address specialty drug challenges

Specialty drugs now account for 30% of total drug costs. Prime predicts that number to reach 50% of total drug spending by 2018. This means using pharmacy benefit tools and member engagement strategies to manage them effectively is important.

"We've found those plan sponsors that are best managing specialty costs have these seven things in common," said Duane Barnes, Prime's senior vice president of consumer delivery. "By deploying these steps and taking a comprehensive approach to understanding specialty costs, plans can both help their members access these important medicines and use them safely and effectively."

A copy of the specialty report is now available on Prime's website and short videos about each of the 7 steps can be found on Prime's YouTube channel. This new report is the first specialty-focused report published by Prime. It follows Prime's 2013 Drug Trend Insights infographic released in May. Visit the Industry Insights of Prime's website for more drug trend information.


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