Jeffrey Albright, director national accounts, Jazz Pharmaceuticals, said that many patients' access to specialty pharmaceutical products can be limited as health plans struggle to control costs. He provided important insight into pharmaceutical manufacturers' strategies, which aim to optimize appropriate patient access to the medications and products they need through various services that can provide reimbursement support.
Jeffrey Albright, director national accounts, Jazz Pharmaceuticals, said that many patients’ access to specialty pharmaceutical products—which treat serious or life-threatening illnesses—can be limited as health plans struggle to control costs. He provided important insight into pharmaceutical manufacturers’ strategies that aim to optimize appropriate patient access to the medications and products they need through various services that can provide reimbursement support.
Mr Albright began by describing the specialty drug landscape. Managing specialty drug costs is a strategic priority for payers. In 2012, specialty drugs accounted for more than a quarter of the total prescription drug spend, and over half of the $7 billion spent on drugs launched in 2012. Seven of the 10 top-selling drugs to be launched within the next 4 years are expected to be classified as specialty. By 2016, pharmacy drug spend is expected to reach $192 billion, and a sky-high total of $400 billion by 2020.
To control costs, payers are implementing a variety of practices. Some include cost-sharing for premiums or deductibles, limiting coupon use, integrating medical with pharmacy benefits, and implementing programs which educate patients and encourage appropriate medication adherence. However, if current premium rate increase trends continue, over 50% of formularies could have co-insurance by 2018. Mr Albright noted that very few patients can afford a 30% coinsurance on a $1,000 per month specialty drug. He said for the patient, “it becomes unstainable.”
Even with coupon or reimbursement programs, payers are pushing back. Most products now offer coupons, with 75% of patients using coupons for tier 3 drugs. Many payers argue that copay coupons circumvent their management abilities and increase their costs. Mr Albright provided UnitedHealthcare as one example of an insurer that has recently pushed back. In January 2014 they stopped covering 25 drugs which included Lipitor, and in July 2014 they are planning to stop covering several primary care drugs. By doing this, they avoid the cost losses associated with drug coupons. If they don't cover it, they don't have to accept the coupons. Still, Mr Albright noted that while UnitedHealthcare said in March 2014 it would no longer accept coupons, it reversed its decision by April. He suspects there will eventually be a larger movement where other insurers do stop accepting coupons.
Mr Albright suggested that despite these trends, there may be alternatives to managing specialty drug costs. Employers, for instance, believe wellness programs and consumer-driven health plans are the most effective ways to contain costs. Manufacturers and payers may focus on specialty pharmacy services which can include individualized patient education, proactive intervention for medication adherence, and utilizing/sharing patient data across integrated technology networks.
“If we can get involved with some of these things, I think that this is a potential way of the future," said Mr Albright. "We can partner with payers where we’re not just bringing them a rebate check, we’re not just differentiating our product on price, but we’re differentiating our product based on a broader range of items."
ATS 2024: Bridging the Past, Present, and Future of Respiratory Care
May 16th 2024The application of artificial intelligence in medicine is anticipated as a highlight of ATS 2024, with sessions exploring its applications in research, radiological interpretation, and pediatric pulmonology.
Read More
Congress Urged to Repeal Comstock Act Threatening Reproductive Rights and Public Health
May 16th 2024In a joint letter addressed to Congress, Healthcare Across Borders, Take Back the Court Action Fund, and UltraViolet Action called out the resurgence of the Comstock Act, urging immediate action to repeal this century-old law that threatens reproductive rights and public health in the US.
Read More
CMS Medicare Final Rule: Advancing Benefits, Competition, and Consumer Protection
May 7th 2024On this episode of Managed Care Cast, we're talking with Karen Iapoce, senior director of government products and programs at ZeOmega, about the recent CMS final rule on Medicare Part D and Medicare Advantage.
Listen
Panel Addresses Minority Physician Shortage, Maternal Health at Senate Committee Hearing
May 15th 2024The senate hearing held by the US Senate Committee on Health, Education, Labor, and Pensions, led by Sen. Bernie Sanders (I, Vermont), chairman of the committee, and ranking member Sen. Bill Cassidy, MD, (R, Louisiana), addressed the critical issue of physician and health care worker shortages, as well as the maternal health crisis, in the US.
Read More