WEBINAR: Emerging Models for Managing Specialty Pharmacy Costs
Recorded March 24
Rare, severe and chronic conditions are often treated using specialty pharmaceuticals, which may be delivered by infusion in the home or institutional settings. Close to 50% of new drugs coming to market qualify as specialty drugs. The costs can range from several hundreds to several thousands of dollars a month. Some cost more than $100,000 per dose. The rising cost is a concern to plan sponsors and to members who bear these diagnoses. When members cannot afford their pharmacy copay, they may decline to participate in treatment, risking further medical complications and higher plan costs.
Because the patient out of pocket costs are very high for patients with these rare and chronic conditions in traditional health plans, drug manufacturers have created financial assistance programs, which can make them more affordable for patients. Application for financial assistance can be complex and frustrating for members, and they may not be able to find out all the programs for which they may be eligible.
Pharmacy benefit management companies (PBM), such as HealthSmartRx Solutions, can help members navigate the financial assistance programs, resulting in cost savings, better clinical outcomes and higher member satisfaction. HealthSmart's approach can result in 10-15 percent savings for plans and reduce member copayments to zero dollars.
After watching this webinar, participants will:
- Understand the financial impact of managing the cost of specialty drugs, whether their use falls under the medical or pharmacy benefit
- Recognize that effective case management contributes to better clinical outcomes and higher member satisfaction in cases of severe, chronic or rare conditions
- Realize the prevalence of rare conditions in a population
- Evaluate emerging models for managing specialty pharmacy costs