Drug Administration: From In Office to At Home | PBMI 2025

An increasing number of drugs can now be administered at home, which increases convenience but can complicate the benefit review process for health plans, according to Nishi Goel, Pharm.D., vice president of customer experience, Agadia.

Drugs that are picked up at the pharmacy are typically covered through the pharmacy benefits, while drugs given at a hospital or outpatient facility are generally covered through the medical benefit.

“Right now, medical and pharmacy are very siloed,” Goel said in a recent video interview with Managed Healthcare Executive. “What plans are seeing is that when you put these together, because it's whole patient care, you actually have access to all the data and are able to make a complete analysis.”

One plan that is doing this is Blue Cross Blue Shield Michigan.

Goel said that Botox is currently the number one product reviewed through Agadia’s integrated process, followed by Remicade (infliximab), which is used to treat autoimmune conditions.

Goel presented today at the Pharmacy Benefit Management Institute’s 2025 conference, held this week in Orlando, Florida. Her session was titled, ‘Streamlining Utilization Management for Medical Benefit Drugs.’