As more employees become eligible for a specialty drug, employers are faced with balancing usage with cost. Some employers put a cap on coverage or ask employees to pay a percentage of the medication costs. Employers are also looking at value-based initiatives and case-management programs — two tactics that have been used to contain costs of chemical drugs but have yet to be applied to specialty drugs.
“Value-based initiatives have been effectively used by many employer plan sponsors for non-specialty medications for years — so those approaches can work,” says Timothy C. Wentworth, president, sales and account management, at Express Scripts. Also, says Wentworth, the “robust library of specialty patient intervention and outcomes suggests that patient case management is effective at identifying potential issues and improving quality of care for the patient.”
The pharmacy landscape changes several times each year and quite dramatically when drug utilization snapshots are compared every 3 to 5 years, says Wentworth. “PBMs and specialty drug providers have significant experience with this type of ongoing education. For example, clinicians and account teams have quarterly and annual reviews with our clients, and these reviews cover new drugs and dynamics in the specialty space.”