The Impact of Rising Costs, Payer Strategies and Value Assessment Tools in Managed Care Pharmacy | AMCP Nexus 2023

Prior to the IRA, there were no limits on beneficiary OOP spending throughout the year. However, by 2025 the IRA will introduce the $2,000 maximum OOP expenses.

The Minnesota-based pharmacy benefit manager says a program that resulted in patients switching from two incretin therapy prescriptions to one yielded $7,500 in savings per patient and a total of $3.5 million.

In a platinum award winning poster presented at the AMCP Nexus 2023 conference in Orlando, “Specialty drug use varies by race and wage among employees with employer-sponsored health insurance,” authors expressed that spending on specialty medications for autoimmune conditions has increased in recent years, raising affordability concerns for employers.

Research continues to develop new therapies for rare cancers and to provide options that allow for fewer toxicities. At the same, however, more new drugs are launching with high price tags.

Adopting evolving computer system tools like artificial intelligence and machine learning in managed care pharmacies have resulted in efficiency when addressing the challenges they are faced with, according to Jessica Hatton, PharmD, BCACP, associate vice president of Pharmacy at CareSource and Nick Trego, PharmD, senior vice president of Clinical Analytics and Client Services at HealthPlan Data Solutions, Inc.

The program yielded savings of $25,000 per patient in its pilot phase but is not expected to produce savings as a routine offering because reimbursement for home infusion was matched to reimbursement at a facility. Horizon executive Timothy O’Shea, Pharm.D., M.S., says cost savings were a “secondary outcome” of the program and noted the high patient satisfaction.