“The health plan was able to obtain significant savings from the program over a 12-month period,” Rodriguez said. “This savings was achieved even with the health plan being able to treat 30% more patients on these medications. The average allowed drug cost per patient decreased from $19,985 (pre-implementation) to $13,346 in the last quarter of the program review period.”
As specialty drug costs continue to be a leading driver of overall drug trends, it is critical for payers to stay current with the evolving management strategies and marketplace conditions impacting medical pharmacy utilization and spend, according to McKinley.
“Understanding medical benefit drug spend, trend, pipeline, and impact is imperative to formulating innovative solutions for managing specialty drug costs,” he said. “A number of specialty medications cannot be self-administered and have to be administered by a healthcare professional. This leads to a number of specialty medications being billed under the medical benefit. There are thousands of specialty medications in the pipeline which are expected to drive a significant portion of future medication costs and inflationary trends.”
Innovative targeted programs and working collaboratively are a few strategies that healthcare executives can implement to help slow the medical pharmacy trend, according to McKinley. “These programs and collaborations can lead to optimized medication use which can minimize waste and lower costs,” he said.
“Medical specialty medication trends will continue to soar,” McKinley said. “Specialty pipeline medications are being created with amazing biotechnology and gene altering techniques to treat our most complex, high-cost healthcare conditions such as cancer, rheumatoid arthritis, and unique rare diseases.”