What Goes into Creating a New Care Management Program for a Specialty Pharmacy?

Jon Gavras, MD, chief medical officer at Prime Therapeutics, discusses what considerations must be made to create a care management program in the specialty space.

Gavras: All patients that are on specialty pharmacy medications are complex just by the nature of the drugs that they are on. More and more, really when you look at who are the complicated, complex members from an illness standpoint, they’re almost always on a specialty medication. If you really want to identify those members, you look at who is on a specialty medication.

When we are developing a program, we really want to look at the components of treating the member holistically—so, understanding the whole biopsychosocial spectrum of what goes into those patients since it is very complicated.

Making sure they take their drugs because these are not only very expensive drugs but very effective drugs so you want [patients] to take them because if [patients] don’t take them, they really won’t get the full effect of the drug.

And you really want to work with the members so they have a close connection with the pharmacy and the care managers to make sure we can help them navigate their way through a pretty complicated system.