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Published: February 23, 2016

The pros and cons of rising specialty drug costs

The increase of specialty drug costs is something that cannot be denied or ignored. According to a study done by the Kaiser Family Foundation and Truven Health Analytics, prescription drug spending accounts for 10% of the national spending on healthcare. The percentage is even higher for self-insured employers.

Let’s talk about the two consequences, one good, one bad, with significant impact on the pharmaceutical industry that occur when the cost of specialty medications increases.

  1. At-risk contracts for pharmaceutical manufacturers become standard

In November 2015, Pharma’s at-risk day in the U.S. squarely arrived with the announcement of the Harvard Pilgrim deal with Amgen for the PCSK9 inhibitor Repatha. The gist of the agreement is that Harvard Pilgrim will recoup additional rebates from Amgen if patients on Repatha do not achieve specific cholesterol targets for various patient groups. Given the need for improved alignment within the industry as a whole (manufacturers, payers, providers and patients), this development is a good thing.

So what is the key step to take to generate value from these contracts? Consider leveraging relationships with specialty pharmacies.  Here’s what these pharmacies can offer:

  • Programs proven to improve adherence
  • Ability to act as a near-neutral third-party for health outcomes metrics arbitration
  1. Barriers to treatment access, caused by complex prior authorization processes, cause patients to defer treatment

The barriers to treatment access, even preventative treatment, created by increasingly complex prior authorization processes and state budgets stretched to the breaking point are causing patients to defer treatment. This is not good. One unintended consequence of the Affordable Care Act is that while it did create the intended effect of increasing the number of insured Americans, it also created a bottleneck of patients awaiting authorization of the exact therapies, or actual cures, for which payers previously clamored.

How do we combat the consequences of increasing the costs of specialty drugs? We must work to break down the barriers to medication access, invest in access solutions and commit to defining value as outcomes divided by costs.

At Curant Health, we believe that investing in the right roles, like that of a prior authorization pharmacist whose sole focus is on securing patient access to needed medication as quickly as possible, will raise the value of our care and the outcomes of our patients. This investment supports our never-changing goal of providing patient education and specialty regimen adherence resources for patients with multiple chronic conditions.

Want to read Curant COO Marc O’Connor’s full article on the influence of rising specialty drug costs? Visit Specialty Pharmacy Times.

If you would like to start a conversation with us on both the good and bad to come from increasing specialty drug costs, drop us a line and we’ll get back to you quickly.

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