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Study Shows Tightly Managed Specialty Pharmacy Benefits Can Cut Specialty Drug Spend in Half

Thursday, March 07, 2013   (0 Comments)
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According to a new study by Express Scripts, employers who use multiple cost-management programs have a 50 percent lower specialty drug trend compared to those who do not.

The study was presented at the National Business Group on Health’s (NBGH) Business Health Agenda 2013 in Washington DC.

Specialty drug costs are increasing for multiple reasons, such as price inflation, an increase in utilization, and new drugs entering the market. Some specialty medications can cost up to $100,000 per person per year.

"Specialty drug costs and use have escalated without sufficient oversight to manage waste or misuse of these expensive medications. Add in the impact of bad health decisions and you get both poor financial and clinical outcomes,” Glen Stettin, MD, senior vice president, Clinical Research & New Solutions at Express Scripts stated. "This data clearly demonstrates that multiple progressive management solutions mitigate the rising cost of specialty therapies by identifying and seizing cost-saving opportunities, as well as enabling better decisions that can lead to improved health outcomes.”

Researchers from Express Scripts analyzed 60 employer clients’ specialty drug spend, all of which are members of the NBGH representing over five million Americans with pharmacy benefits. They then separated the employers into one of three groups: unmanaged, somewhat managed, and tightly managed. They categorization was based on the type of cost management programs the employers adopted.

In the unmanaged group, employers’ health plan members are able to obtain their specialty medications from any pharmacy and did not use any specialty utilization management programs. In the somewhat managed group, employers’ health plan members used a specialty pharmacy exclusively and one specialty utilization management program. In the tightly managed group, employers’ health plan members used a specialty pharmacy exclusively combined with multiple specialty utilization management programs.

They found that employers classified as unmanaged had an annual average increase in specialty drug spending per member per year (PMPY) of 27.8 percent whereas employers classified as tightly managed saw an annual increase in specialty drug spending PMPY of 13.6 percent. This represents half of the unmanaged group, and nearly one-third lower than the average annual projected specialty drug trend of 18.4 percent. In addition to a decrease in specialty drug spending PMPY, tightly managed programs also saw higher average member adherence rates in top therapy classes.

According to Express Scripts, the employers who are tightly managing their specialty drug plans are saving tens of millions of dollars versus those who are considered unmanaged.

Source: Express Scripts

Last Updated: 3/7/13; 2:20PM EST

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