Q&A: Mayo Clinic leaders share strategies for managing high-cost drugs without breaking the bank | Asembia AXS26 Summit

At the Asembia AXS25 Summit this week, pharmacy leaders from Mayo Clinic discussed how health systems can better manage rising drug costs while maintaining patient access and quality of care. Adam Ewald, Pharm.D., M.H.A., director of innovative pharmacy programs, and Chelsee Jensen, Pharm.D., director of formulary management, shared insights during their session, “Cracking the Code Without Breaking the Bank: Master High-Cost Drug Management.”

The below Q&A has been edited for clarity.

Managed Healthcare Executive (MHE): As the cost of specialty and high-cost drugs continues to rise, how do you define and group these drugs to support better formulary decisions and use of resources?

Ewald and Jensen: Each health system will have its own definition, but we define a high-cost drug as any medication administered by a healthcare professional that has an acquisition cost of $50,000 per dose or higher. This is not a fixed definition, and we may review other drugs that create financial or operational complexities. Like many health systems, we have established a high-cost drug committee process and review these drugs holistically with subject matter experts across the healthcare continuum. We combine this process with our standard formulary review to evaluate safety, efficacy, cost, value and operational needs to provide access for patients.

MHE: From both a formulary and supply chain perspective, what are some practical strategies health systems can use to balance patient access with cost, especially for site-of-care decisions, purchasing and contracting?

Ewald and Jensen: We first review safety and efficacy to determine the clinical need and where the drug fits into the therapy landscape. If the drug is safe and effective and meets a patient’s need, we then evaluate the financial picture. We review cost, where the drug will be administered or dispensed, and the payer landscape. We also assess contracting needs, risks to the organization and patients, and any opportunities to reduce cost. Many of these factors are drug and manufacturer specific. After this, we decide whether the product can be added to the formulary and made available to patients.

MHE: Non-340B health system specialty pharmacies face unique challenges. What are the biggest issues they are dealing with today, and where do you see opportunities to stay competitive?

Ewald and Jensen: The benefits of health system specialty pharmacies are well established, but non-340B systems face growing financial pressures as costs rise and reimbursement constraints increase. These challenges are further complicated by new high-cost therapies that may lack clear pricing and access strategies for non-340B systems. Despite this, health system specialty pharmacies continue to deliver care that often matches or exceeds other models, especially in clinical integration, care coordination and patient outcomes.

To stay competitive, these pharmacies must operate in a financially sustainable way while continuing to support patient care. This will require stronger collaboration with manufacturers and payers to develop pricing, access and reimbursement strategies that reflect the value they provide. Supporting their sustainability is critical because they play a key role in managing high-cost therapies and improving care quality.

MHE: Based on your presentation, what is one key takeaway that managed care and health system leaders should focus on right now?

Ewald and Jensen: The need for a truly collaborative approach across organizations and stakeholders. As high-cost therapies continue to enter the market and drug spending rises, no single group can manage these challenges alone. Success will require closer alignment among health systems, manufacturers and payers to keep therapies accessible and affordable while maintaining quality of care.