Additional drug benefit possible

November 1, 2009
Allison Tsai
Allison Tsai

Allison is an Advanstar associate editor

Over the next 20 years, expect to see funky formularies and new drug benefit designs to manage costs

NATIONAL REPORTS-Though a two-tier formulary for generics and brand-name drugs was cutting edge 20 years ago, this decade has given rise to the three-tier formulary, according to Perry Cohen, president of The Pharmacy Group. He predicts the third tier will likely expand within the next 20 years.

"Specialty health benefits will deal mostly with drugs that are currently in tier four and five, because they are specialty drugs that cost perhaps $10,000 a year," says Cohen. "So, over the next 20 years you're going to see traditional drugs covered under a three-tier copay system, but that third tier is going to get more funky."

"So the incidence is really small, the drugs are expensive, and they need a lot of case management to go with it, such as tracking, use, genetic testing-and all those things are going to lead to a third category of health benefits, called specialty health benefits."

In addition, Cohen says the market is moving from drug formulary management toward drug utilization management.