Specialty Pharmacy Management Trends

Debbie Stern, RPh; Becki Fenrick, PharmD, MBA; and Michael Fine, MD, presented on specialty pharmacy management trends on Friday at the Academy of Managed Care Pharmacy (AMCP) 24th Annual Meeting.

The presenters touched on a number of updates to the EMD Serono Specialty Digest. For starters, more detailed analysis of prior authorization and preferred product strategies is provided by therapy category. In addition, strategies related to palliative and end-of-life care for oncology patients are clearly identified. Payers also provided input on specific interventions and outcome measures for hepatitis C, multiple sclerosis, oncology, and rheumatoid arthritis.

Following the overview and introduction, the presenters then shared data from the surveys that had been given for the 8^th edition of the EMD Serono Specialty Digest. Here are some of the general findings:

When asked to rank of a scale of 1-5 the factors determining classification as specialty pharmacy, here is how those polled responded:

• High cost (84%)
• Requires special handling (68%)
• Treats rare disease (63%)
• Limited distribution (63%)
• Requires ongoing assessment of response (47%)
• Requires patient administration training (38%)
• Requires monitoring of side effects (32%)
• Drug has an FDA mandated REMS (29%)

The presenters also touched on the top therapy categories specified by specialty pharmacy. The top 3 categories in 2011 were growth hormone disorder, rheumatoid arthritis/Crohn’s disease, and multiple sclerosis.

Those polled were also asked to rank strategies to manage across pharmacy and medical benefits. The results were as follows:

• Clinical criteria covers the entire therapy category across benefits (71%)
• Pharmacy department manages specialty drug PA across benefits (62%)
• Contract with one SPP to manage distribution of specialty drugs across benefits (38%)
• Allow “buy and bill” with same reimbursement rate for SPPs and physicians (31%)
• SPP manages specialty drugs across benefits (29%)
• Eliminate “buy and bill” for physicans with mandatory SPP across benefits (20%)
• Out-of-pocket maximum across the benefits (13%)
• Equal cost share for specialty drugs across benefits (6%)
• Non-SPP external vendor manages specialty drug PA across benefits (6%)

The speakers also discusses some of the current specialty drug trends and issues, such as an increasing number and cost of specialty drugs, reimbursement isses as they relate to the regulatory picture and healthcare reform, and increased utilization management.

For more information about this presentation, please visit www.amcp.org.