February 9, 2016 - Curant COO, Marc O'Connor, in Specialty Pharmacy Times - The meteoric rise of specialty drug cost has been well-documented and appropriately lambasted, at least in some circumstances. According to a recent report by the Kaiser Family Foundation and Truven Health Analytics, prescription drug spending accounts for 10% of national spending on health at approximately $300 billion.
Moreover, specialty drug cost spending in employer health plans is nearly double that share at 19%.1 Two consequences of the growing cost for specialty medications percolated to the top of my list when considering its ability to impact the specialty pharmaceutical industry.
First is the arrival of the pharmaceutical manufacturers’ day at-risk.
Pharma’s Day At-Risk is a Good Thing In November 2015, pharma’s at-risk day in the United States arrived with the announcement of the deal between Harvard Pilgrim and Amgen for the PCSK9 inhibitor, Repatha. The gist of the agreement is that Harvard Pilgrim will recoup additional rebates from Amgen if various patient groups taking Repatha do not achieve specific cholesterol targets. Given the need for improved alignment within the industry as a whole (manufacturers, payers, providers, and patients), this development is a good thing. If manufacturers and payers would allow them to do so, specialty pharmacies could serve as the primary conduit, or arbiters if you will, that enable both parties to generate value from at-risk agreements. Now we will explore how this can be achieved.
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