Specialty medications and managed care: The impact and forecast

October 21, 2015
Aubrey Westgate
Aubrey Westgate

How will the increasing number of approvals for specialty medications affect managed care? Aimee Tharaldson, of Express Scripts, weighs in.

How will the increasing number of approvals for specialty medications affect the healthcare industry and managed care pharmacy specifically?

That's a question that Aimee Tharaldson, PharmD, will seek to answer during her October 27 presentation at the Academy of Managed Care Pharmacy Conference (AMCP) Nexus 2015.

"The primary focus [of the session] will be to discuss pipeline medications and drugs in development in the specialty pipeline," says Tharaldson, a senior clinical consultant in emerging therapeutics at Express Scripts. "Specialty medications are very expensive and account for a significant portion of the prescription drug spending. It's important to know what's going to the market and how [these medications] will potentially impact the market."

The high price of these specialty medications, combined with the high number that have recently been approved and will likely be approved in 2016, could significantly affect the industry, she says.

"FDA is approving a significant number of specialty medications every year," says Tharaldson. "Last year, FDA approved 27 new specialty medications, so we are seeing a lot of drugs get approved that cost a lot of money. The average cost [of these medications] is more than $2,500 [per member] per month."

Moving into 2016, Tharaldson expects more competition to develop in the specialty pharmaceutical arena. More drugs are emerging with similar mechanisms to treat conditions, she says, pointing to psoriasis as an example. Several medications to treat the condition are nearing FDA approval, she says.

Other increasingly competitive areas include specialty medications for rheumatoid arthritis, hepatitis C, and hemophilia, says Tharaldson.  

"We are also seeing significant cancer drug development," she says, adding that nine new cancer drugs were approved last year, seven were approved this year, and 10 more may be approved within the next six months.

During her presentation, Tharaldson will share more specifics on the various medications likely to be approved in 2016.

She will also discuss orphan drug development. Orphan drugs, which treat rare diseases and disorders that affect fewer than 200,000 people in the U.S., represent an "unmet need" and will have a "significant impact" on the industry, says Tharaldson.

Tharaldson's session, “Specialty Pharmaceuticals in Development," will be held from 8:00 a.m. to 9:15 a.m. on Tuesday, October 27.