MCOs see value in personalized medicine

January 15, 2009

Pharmacogenomics offer value measures to MCOs as specialty drug costs skyrocket.

Plan sponsors are concerned with rising prescription costs but are willing to adapt to medical and scientific innovations, according to experts.

“More plan sponsors are seeing value in measures to ensure patients get more precise pharmacy care, such as gene testing,” says Janine Nowatzky, senior director, market strategy, Medco’s Systemed. “Or they attempt to better manage patient care either through wellness or disease management.”

A study conducted on behalf of Medco by Haldy McIntosh and Associates polled 295 pharmacy benefit decision makers from leading corporations, as well as nonprofit, labor, and public sector groups with at least 500 eligibles. The study assessed perceptions regarding the pharmacy benefit and understand current and future approaches plan sponsors are relying on to control prescription drug costs.

Specialty drug costs are becoming a larger driver of pharmaceutical spending, since these treatments are gaining greater use.

“With some drug regimens costing thousands of dollars annually for a patient, it is a growing concern for any plan sponsor,” says Nowatzky. “An aging population is also a big factor in driving of demand for pharmacy care.

However, health plan sponsors are not helpless to mitigate some of these dynamics either through plan design or utilization management.”

Additionally, adverse drug events result in 100,000 deaths and more than 2 million hospitalizations in the United States each year, according to the Mayo Clinic, so drug use must be approached with care.

“The promise of personalized medicine or pharmacogenomics offer opportunities to reduce these risks, thereby reducing healthcare costs and improving the quality of life for patients,” says Nowatzky.

Managed care executives should be aware of medical innovations that can help improve safety and reduce wasteful spending, according to Nowatzky. “Gaining a clear understanding of how genetic tests-or personalized medicine-can help physicians prescribe the right drug at the right dose for the right duration early in a patients treatment regime, will lower overall healthcare costs for the payer,” she says.

Medco has enrolled 100 clients in its Personalized Medicine Program.