Connected in Care: A Proactive Approach to Managing Specialty Drugs

It’s not news that specialty drugs account for a disproportionately high percentage of overall drug spend. As more of these drugs come to market, it’s increasingly important for payors to have an end-to-end strategy for managing utilization, from the start of therapy and continuing for as long as the member is on the drug, to help promote better health outcomes and control costs.

Specialty medications are used to treat complex medical conditions like hemophilia, autoimmune diseases, cancer, and HIV. While only a small percentage of people rely on them, the impact on spend is remarkable.

Prior authorization has long been used to help manage utilization. However, the majority of specialty drug spend occurs beyond the first fill. So, it’s critical to connect with members who use specialty medications, as well as their care teams, throughout the duration of therapy to monitor effectiveness, adherence, and changes in symptoms and health status, so that we can proactively determine when adjustments may need to be made.

Optimizing connections to optimize outcomes and cost

Given the growing consumer demand for digital connectivity, plan sponsors have a significant opportunity to yield higher value when they work with a PBM partner that proactively uses digital innovation to engage with patients and providers as an integral part of its specialty utilization strategy. This includes connecting electronic health record (EHR) data, real-time benefits visibility plan members and their providers can view at the point of prescribing and beyond, and ongoing touchpoints with patients to monitor how treatment is going.

During our 2022 Forum, Cassandra Ford, PharmD, AVP, Clinical Account Services, and Tierra Ford, PharmD, Senior Clinical Advisor of Specialty Client Solutions, talked about what that looks like, including a case study on a hemophilia patient to illustrate how these interventions work in practice.

Watch more 2023 Forum highlights here →