Controlling Specialty Drug Costs (Video)

Specialty Drug Costs Can Be Managed with These Strategies
specialty drug costs

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“It’s interesting that a lot of these specialty drugs are designed for a very small percentage of the population that have a certain disease state,” said Michael Cornwell, MedCost Director of Sales and Underwriting.

“There may be less than 200,000-300,000 people in the country that need that particular drug. That’s one of the reasons specialty drugs are so expensive.”

MedCost Pharmacist Zafeira Sarrimanolis agrees. “It’s an exciting time in the drug manufacturing world, because all of these new medications have been coming out over the past ten years or so for medical conditions that really weren’t treatable before.

“For example, hepatitis C medications previously were not very effective and really hard for patients to tolerate. Now we have new medications on the market that are practically a 100% cure rate for patients.

specialty drug costsThese drugs are also a lot easier for them to take and tolerate. Part of the problem with that is the price tag on some of those new medications.”

“One of the largest reasons people are readmitted to the hospital is because they don’t adhere to the medication,” said Michael Cornwell. “Programs like step therapy ask you to try a clinically appropriate drug before you try a similar but more expensive one.

Prior authorizations probe a physician’s reasoning behind prescription choices. A lot of these specialty drugs are really for a pretty small percentage of the population. So when you look at a population as a whole, the people taking those drugs are usually between 1%-1½% of your population. That’s the good news.

“The bad news is they’re very expensive. Probably the biggest growth area in the specialty arenas are the cancer drugs. There’s a whole pipeline of new cancer treatments hitting the marketplace. But in that pipeline, member education and aid in helping and consulting is a good thing too. It allows us to have some personal outreach try to help these people manage their disease state.MedCost

(This post is a transcript from the video, CONTROLLING SPECIALTY DRUG COSTS.”)

 

Facing Life’s Biggest Challenges

Margaret Nunez image

Three and a half years ago, Margaret Nunez first experienced MedCost’s Complex Case Management program when she was diagnosed with Multiple Myeloma, a type of cancer that causes abnormal plasma cells to accumulate in bone marrow and interfere with the production of normal blood cells. The disease is considered incurable but treatable.

Margaret received radiation and chemotherapy and responded well to the treatment. She also underwent a successful auto stem cell transplant. Several months later, with her condition stable, Margaret’s case management file was closed.

When later tests indicated an increase in Myeloma markers, her case management file was re-opened. While participating in the program this second time, Margaret was diagnosed with breast cancer and underwent surgery, followed by radiation. During breast cancer treatment, her Myeloma maintenance therapy was discontinued. Once the breast cancer treatments were over, she restarted maintenance therapy. Since her condition was stable, her case management file was closed once again.

Several months later, Margaret re-joined the program after a brief hospital admission for neutropenic fever. Neutropenia is an abnormally low count of white blood cells and makes an individual vulnerable to infection. Margaret’s next bone marrow biopsy showed persistent Myeloma.

“Having the same person follow my case from before my stem cell transplant and then periodically since then has been so important. I’ve been through so many changes and my case manager is always there for me.”*

The goal of our Complex Case Management is to ensure the best use of available health plan resources, while enhancing quality of life. For more information, visit our Case Management page or contact Jason at MedCost.

*Margaret Nunez gave MedCost permission to share her story to help others realize the benefits of the Complex Care Management program.