Magazine article Drug Topics

Specialty Drugs and the Role of Managed Care Pharmacy

Magazine article Drug Topics

Specialty Drugs and the Role of Managed Care Pharmacy

Article excerpt


B Specialty pharmaceuticals will have a profound impact on the practice of pharmacy over the next 10 years. They will affect all pharmacy practice settings and accelerate the importance of medication management to ensure the appropriate use of these important therapeutic agents.

For treatment of chronic diseases (e.g., asthma, diabetes, hypertension, etc.) in large patient populations, the current practice of dispensing and distributing traditional drugs through retail and mail pharmacies will continue.

Specialty pharmaceuticals, which tend to be directed toward smaller patient populations, have a different model for distribution. They require special storage and handling, dose patient monitoring, and complex clinical management.

The accompanying chart shows current distribution channels for specialty medications. Retail, mail, and spedalty pharmades account for the distribution of about 45% of spedalty drugs.

As can be seen, the other 55% is distributed primarily from the physidan's office, with outpatient hospital and home infusion making up the rest.

Coming soon

The current use of limited sites of service for infused and injedable drugs will change over the next 10 years, as managed care pharmacy practice will move spedalty drug volume to the providers who can make a positive impati on health outcomes in the most cost-effective way.

The next 10 years will also see the emergence of a specialty pharmadst, based in the physidan's office, who will manage the patients taking certain spedalty medications.

As the costs of spedalty pharmaceuticals escalate, some in excess of $50,000 annually (e.g., Solvaldi, Olysio), it makes sense for managed care to place pharmadsts doser to the patient. Use of these medications will benefit from pharmadst availability to physidans or even, through housecalls, to patients in their homes.

Areas of focus

Ultimately, a managed care pharmacy practice will focus on the following areas.

daims administration. The managed care pharmadst can determine whether a spedalty drug falls under the medical or pharmacy benefit

Cost management. The managed care pharmadst can determine whether a specialty medication should be administered in the physidan's office or a pharmacy, and can also manage those pesky medication lists.

Utilization management. The managed care pharmadst can be responsible for prior authorizations and tracking, handle compliance matters and follow-up, and measure health outcomes. …

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