HealthSmart’s Innovative Approach to Reducing Specialty Pharmacy Costs
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. By definition, the cost runs to several hundreds of dollars a month. Some cost more than $100,000 per dose. The rising cost is a concern to plan sponsors and 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 (PBM) companies, such as HealthSmartRx Solutions, can help members navigate the financial assistance programs, resulting in cost savings, better clinical outcomes and higher member satisfaction.
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
Martino Luu, RPh
EVP & General Manager, HealthSmartRx Solutions
Martino Luu is an expert in clinical and pharmacy operations, with experience working with leading specialty pharmacies and PBMs. He graduated from pharmacy school at Rutgers University and completed his MBA in entrepreneurship at the Silberman School of Business at Fairleigh Dickinson University. He is a licensed pharmacist in Texas, Florida, Tennessee and New Jersey.
Pamela Coffey, RN
EVP, Chief Clinical Officer, HealthSmart
Pam Coffey leads HealthSmart’s clinical programs, including Care Management and HealthSmart Primary Care Clinics, delivering predictive population management methodologies and flexible plan designs. An accomplished healthcare executive with more than 25 years’ experience, she has an extensive background in managing risk, as well as structuring data-centric clinical management programs with expertise in operations and clinical programs.
Executive Vice President, Chief Sales & Client Officer
Tom Mafale is an accomplished and award-winning executive, with more than 30 years' experience in leading sales, sales operations, marketing and client services teams, with expertise in commercial health plans, self-funded plans and stop loss.