Specialty Meds - What Do They Mean to Your Plan Cost?

If you’re managing a self-funded health plan in 2021, I’m certain you’re aware of specialty medications and what they mean to your plan cost. 

The topic by the way got some fairly good press two weeks ago in the Indianapolis Business Journal.

But what characteristics define a specialty medication? And, more importantly, what aspects of specialty medication can you impact to manage cost?

I incorporated this question into the latest episode of Wee Dose of Radical Transparency.

You can listen the 3 minute episode here: https://youtu.be/YzmVXf1nIK8

Broadly accepted, specialty meds are defined as those that are a high cost medication, requiring complex administration (biotech, infused, injectable), requiring special handling and/or storage, available through limited distribution channels, and/or requiring clinical monitoring of patient's therapy.

These medications include short-term regimens as well as maintenance treatments for chronic conditions. 

Complex administration is one aspect that comes with a lot of considerations – But, as a plan sponsor, don’t be intimidated. You don’t have to remain hands-off.

Administering specialty medications in the physicians’ office or patients’ home, instead of hospital outpatient settings many times offers substantial savings opportunities – And, can likewise, minimize disruption to your employee.

For further clarification:

(1) site of care management is focused on redirecting specialty patients to the lowest cost and most clinically appropriate location for their infusions.

(2) For most plan sponsors, site of care represents the single biggest savings opportunity across specialty drug management.

(3) Often the top five conditions driving costs are: Multiple Sclerosis, Immune Deficiency, Rheumatoid Arthritis, Inflammatory Bowel Disease, Chemotherapy for cancer. 

So, a lot of opportunity here – Keep in mind though, going it alone is a tall task. You’ve got to set these conversations in motion from the outset of your pharmacy benefits manager relationship as well as ensure you’ve got the right professionals in your corner with careful monitoring throughout the year.

If you want to dig in further into these topics, just reach out. 

Send me a message here on LinkedIn or reach out to me on slong.apexbg.com

Until next time, be well!