Specialty medications: Traditional and novel tools can address rising spending on these costly drugs

Health Affairs

Volumn 33, Issue 10, 2014, Pages 1736-1744

  Lotvin, Alan M ^a   Shrank, William H ^a   Singh, Surya C ^a   Falit, Benjamin P ^a,b   Brennan, Troyen A ^a  

^a CVS Caremark   (United States)

^b BRIGHAM AND WOMEN S HOSPITAL   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

PRESCRIPTION DRUG; ANTINEOPLASTIC AGENT; BIOLOGICAL PRODUCT;

ARTICLE; BILLING AND CLAIMS; COST CONTROL; DISEASE SEVERITY; DRUG COST; DRUG THERAPY; FOOD AND DRUG ADMINISTRATION; HUMAN; ONCOLOGY; PHARMACY; PHYSICIAN; REIMBURSEMENT; SPECIALTY MEDICATION; ECONOMICS; HEALTH CARE COST; NEOPLASMS; PROCEDURES; STATISTICS AND NUMERICAL DATA; UNITED STATES;

ANTINEOPLASTIC AGENTS; BIOLOGICAL PRODUCTS; COST CONTROL; DRUG COSTS; HEALTH CARE COSTS; HUMANS; NEOPLASMS; PRESCRIPTION DRUGS; REIMBURSEMENT MECHANISMS; UNITED STATES;

EID: 84907807267     PISSN: 02782715     EISSN: 15445208     Source Type: Journal    
DOI: 10.1377/hlthaff.2014.0511     Document Type: Article

References (42)

1. Aitken M, Berndt ER, Cutler DM. Prescription drug spending trends in the United States: looking beyond the turning point. Health Aff (Millwood). 2009;28(1):w151-60. DOI: 10.1377/htlhaff.28.1.w151.
2. IMS Institute for Healthcare Informatics. Declining medicine use and costs: for better or worse? [Internet]. Parsippany (NJ): IMS Health; 2013 May [cited 2014 Aug 19]. Available for download from: http://www .imshealth.com/portal/site/ imshealth/menuitem.762a961826 aad98f53c753c71ad8c22a/ ?vgnextoid=5b21ee0a8e631410 VgnVCM10000076192ca2RCRD
3. CVS Caremark. 7 sure things to help you know where to go next with your prescription benefit [Internet]. Woonsocket (RI): CVS Caremark; 2014 [cited 2014 Aug 19]. Available from: http://info.cvscaremark.com/ insights2014/INSIGHTS%20Trend %202014-v2.pdf
4. Evaluate Pharma.World preview 2014, outlook to 2020 [Internet]. London: Evaluate; [cited 2014 Sep 3; login required]. Available for download from: http://www.evaluate group.com/public/Reports/Evaluate Pharma-World-Preview-2014.aspx
5. Berndt ER, Newhouse JP. Pricing and reimbursement in U.S. pharmaceutical markets. In: Danzon PM, Nicholson S, editors. The Oxford handbook of the economics of the biopharmaceutical industry. New York (NY): Oxford University Press; 2012. p. 201-65.
6. EMD Serono. EMD Serono specialty digest, 10th edition: managed care strategies for specialty pharmaceuticals [Internet]. Washington (DC): EMD Serono; 2014 [cited 2014 Aug 19; login required]. Available for download from: http://www .specialtydigest.emdserono.com/
7. Grabowski HG, Guha R, Salgado M. Regulatory and cost barriers are likely to limit biosimilar development and expected savings in the near future. Health Aff (Millwood). 2014;33(6):1048-57.
8. Kocher R, Roberts B. The calculus of cures. N Engl J Med. 2014;370(16): 1473-5.
9. Food and Drug Administration, Center for Drug Evaluation and Research. Novel new drugs 2013: summary [Internet]. Silver Spring (MD): FDA; 2014 Jan [cited 2014 Aug 19]. Available from: http:// www.fda.gov/downloads/Drugs/ DevelopmentApprovalProcess/ DrugInnovation/UCM381803.pdf
10. Vogenberg FR, Larson C, Rehayem M, Boress L. Employers need to better understand the costs of spe-cialty pharmacy. Manag Care. 2013; 22(9):36-40.
11. Prime Therapeutics. Specialty today and tomorrow [Internet]. Eagan (MN): Prime Therapeutics; 2013 Sep [cited 2014 Aug 19]. Available from: https://www.primetherapeutics .com/PDF/specialtydtr2013/index .html
12. Vora JB. Evaluation of medical specialty medications: utilization and management opportunities [Internet]. Chicago (IL): Milliman; 2014 Apr 8 [cited 2014 Aug 19]. Available from: http://info.cvscaremark.com/ insights2014/Singh06-Medical-Specialty-Utilization-and-Management-Opportunities.pdf
13. Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion. The state of aging and health in America 2013 [Internet]. Atlanta (GA): CDC; 2013 [cited 2014 Aug 19]. Available from: http:// www.cdc.gov/features/agingand health/state_of_aging_and_health_ in_america_2013.pdf
14. Midwest Business Group on Health. National employer initiative on specialty pharmacy: specialty pharmacy 101 [Internet]. Chicago (IL): The Group; [cited 2014 Aug 19]. Available from: http://www.specialtyrx toolkit.com/specialty-pharmacy-101/cost-drivers
15. Rockoff JD. Drug makers see profit potential in rare diseases.Wall Street Journal. 2013 Jan 30.
16. O'Riordan M. Strong results from early studies with PCSK9 inhibitors generating big buzz [Internet]. New York (NY): WebMD; 2014 Mar 30 [cited 2014 Sep 3; login required]. Available from: http://www .medscape.com/viewarticle/822814
17. Shoemaker D. The U.S. biosimilar approval pathway: policy precedes science. Contract Pharma [serial on the Internet]. 2014 Jan 8 [cited 2014 Aug 20]. Available from: http:// www.contractpharma.com/ contents/view_experts-opinion/ 2014-01-08/the-us-biosimilarapproval-pathway/
18. Jacobson M, O'Malley AJ, Earle CC, Pakes J, Gaccione P, Newhouse JP. Does reimbursement influence chemotherapy treatment for cancer patients? Health Aff (Millwood). 2006; 25(2):437-43.
19. EMD Serono. EMD Serono specialty digest, 9th edition: managed care strategies for specialty pharmaceuticals [Internet]. Washington (DC): EMD Serono; 2013 [cited 2014 Aug 19]. Available from: http://www .amcp.org/EMDSeronoSpecialty Digest9th.pdf
20. Pharmacy Benefit Management Institute. 2014 PBMI specialty drug report. Plano (TX): PBMI; 2014.
21. Nayak RK, Pearson SD. The ethics of "fail first": guidelines and practical scenarios for step therapy coverage policies. Health Aff (Millwood). 2014;33(10):1779-85.
22. Motheral BR. Pharmaceutical steptherapy interventions: a critical review of the literature. J Manag Care Pharm. 2011;17(2):143-55.
23. O'Dell JR, Mikuls TR, Taylor TH, Ahluwalia V, Brophy M, Warren SR, et al. Therapies for active rheumatoid arthritis after methotrexate failure. N Engl J Med. 2013;369(4): 307-18.
24. Starner CI, Alexander GC, Bowen K, Qiu Y, Wickersham PJ, Gleason PP. Specialty drug coupons may play a substantial role in lowering out-ofpocket costs and improving adherence. Health Aff (Millwood). 2014;33(10):1761-69.
25. Ross JS, Kesselheim AS. Prescription drug coupons-no such thing as a free lunch. N Engl J Med. 2013; 369(13):1188-9.
26. Goldman DP, Joyce GF, Lawless G, Crown WH, Wiley V. Benefit design and specialty drug use. Health Aff (Millwood). 2006;25(5):1319-31.
27. Shrank WH, Hoang T, Ettner SL, Glassman PA, Nair K, DeLapp D, et al. The implications of choice: prescribing generic or preferred pharmaceuticals improves medication adherence for chronic conditions. Arch Intern Med. 2006; 166(3):332-7.
28. Fitch K, Pyenson B. Site of service cost differences for Medicare patients receiving chemotherapy [Internet]. Chicago (IL): Milliman; 2011 Oct 19 [cited 2014 Aug 20]. Available from: http://www.milliman.com/ uploadedFiles/insight/healthpublished/ site-of-service-costdifferences. pdf
29. Kocher R, Sahni N. Rethinking health care labor. N Engl J Med. 2011;365(15):1370-2.
30. Smith TJ, Hillner BE. Bending the cost curve in cancer care. N Engl J Med. 2011;364(21):2060-5.
31. Elkin EB, Bach PB. Cancer's next frontier: addressing high and increasing costs. JAMA. 2010;303(11): 1086-7.
32. Towle EL, Barr TR, Senese JL. The national practice benchmark for oncology, 2013 report on 2012 data. J Oncol Pract. 2013;9(6s):20s-38s.
33. Patel KK, Morin AJ, Nadel JL, McClellan MB. Meaningful physician payment reform in oncology. J Oncol Pract. 2013;9(6S):49s-53s.
34. Bach PB, Mirkin JN, Luke JJ. Episode-based payment for cancer care: a proposed pilot for Medicare. Health Aff (Millwood). 2011;30(3): 500-9.
35. Robinson JC. Providers' payment and delivery system reforms hold both threats and opportunities for the drug and device industries. Health Aff (Millwood). 2012;31(9): 2059-67.
36. Kuntz G, Tozer J, Snegosky J, Fox J, Neumann K. Michigan Oncology Medical Home Demonstration Project: first-year results. J Oncol Pract. 2014 Jul 1. [Epub ahead of print].
37. Mehta AJ, Macklis RM. Overview of accountable care organizations for oncology specialists. J Oncol Pract. 2013;9(4):216-21.
38. Newcomer LN. Changing physician incentives for cancer care to reward better patient outcomes instead of use of more costly drugs. Health Aff (Millwood). 2012;31(4):780-5.
39. Newcomer LN, Gould B, Page RD, Donelan SA, Perkins M. Changing physician incentives for affordable, quality cancer care: results of an episode payment model. J Oncol Pract. 2014 Jul 8. [Epub ahead of print].
40. Kreys ED, Koeller JM. Documenting the benefits and cost savings of a large multistate cancer pathway program from a payer's perspective. J Oncol Pract. 2013;9(5):e241-7.
41. Bach PB. Limits on Medicare's ability to control rising spending on cancer drugs. N Engl J Med. 2009;360(6): 626-33.
42. 42 C.F.R. Sect. 423.120(b)(2)(v) and (vi).