Over the next 12 months, numerous specialty drugs are expected to hit the U.S. marketplace in multiple therapeutic conditions. While certain ones will merely add to already-crowded classes, several should fill gaps in care that are sorely needed. Some will have relatively inexpensive price tags of about $30,000 per member per year … but others are likely to top $100,000. And with additional developments in the specialty space — such as the emergence of oral therapies in classes with previously only infusible treatments and the growing use of genetic testing — managing these drugs will become even more complicated. How are these therapies expected to impact health plans and employers? What steps can you take to lessen their impact on your organization’s bottom line?
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With literally hundreds of drugs in the specialty pipeline, payers need to make sure their management strategies are evolving to fit emerging trends, which can offer both challenges and opportunities. Among these: biosimilar drugs; targeted therapies with diagnostic tests that identify appropriate candidates for treatment; channel management, especially with orphan and ultra-orphan drugs; clinical pathways in not only oncology but also rheumatoid arthritis and multiple sclerosis; and routes of administration, with classes that traditionally have had infusible therapies, which fall under the medical benefit, now seeing oral options that are managed under the pharmacy benefit.
Hear two industry experts discuss which specialty drugs are expected to enter the U.S. marketplace soon and how they can be managed effectively within the evolving specialty pharmacy space. You’ll get valuable perspectives on:
ATHEER KADDIS, Pharm.D., is senior vice president sales and marketing with Diplomat Specialty Pharmacy. His responsibilities include business development, manufacturer contracting, sales, managed markets, and specialty infusion. Dr. Kaddis began his career as a staff pharmacist at William Beaumont Hospital in Troy, Mich., and continued his hospital pharmacy experience as a clinical oncology specialist at Grace Hospital in Detroit; he also worked in the community pharmacy setting. Dr. Kaddis joined Blue Cross Blue Shield of Michigan in 1997 as clinical program manager dedicated to the Ford Motor Company account and also had drug information responsibilities. He joined Merck-Medco (later Medco Health Solutions, Inc.) in 2000 as associate director in clinical account management and then returned to the Michigan Blues plan as director of pharmacy services, clinical, with responsibilities including formulary development, clinical program development, utilization management programs, specialty pharmacy programs and pay-for-performance programs. Dr. Kaddis received his Doctor of Pharmacy degree from Wayne State University in 1994. He is a member of the Academy of Managed Care Pharmacy and Michigan Pharmacists Association.
WILLIAM SULLIVAN is the principal consultant for and founder of Specialty Pharmacy Solutions LLC. For more than 30 years he has held executive positions in health care and pharmacy risk management, particularly for patients with chronic illness. As a recognized leader in the specialty pharmacy marketplace, Mr. Sullivan provides practical solutions for controlling high-cost injectables, infusibles and emerging biotech products. In 2002 he founded Specialty Pharmacy Solutions to provide expert consultative services to clients in the specialty pharmacy niche. Examples of major engagements include the development of multiple therapy-specific treatment management programs; the creation of sales, contracting and clinical delivery programs for more than 30 specialty pharmacies, including the largest joint venture between a national PBM and a publicly traded specialty pharmacy; RFP development /specialty pharmacy vendor selection /contracting /program implementation for major health plans; long-term strategic planning to build pharmacy valuation; due diligence on multiple specialty pharmacy acquisitions of all sizes; and competitive intelligence and managed care strategies for pharma companies. Mr. Sullivan’s pharmacy, sales, business development and operations expertise help his clients develop sound strategies, contain costs and profitably expand their markets. His prior experience in the specialty sector includes senior leadership roles at Priority Healthcare (now Express Scripts/CuraScript) and Adesso Specialty, as well as senior-level product management and sales leadership positions at Blue Cross Blue Shield of Massachusetts and Pilgrim Health Care (now Harvard-Pilgrim). Mr. Sullivan received his MBA in Healthcare Administration from Boston University. He is a member of the Academy of Managed Care Pharmacy and serves on the editorial board for Specialty Pharmacy News.
Moderator: Angela Maas, managing editor of AIS's Specialty Pharmacy News
Pharmacy, clinical services and medical directors; strategic planners; product development, contracting and marketing executives; and financial and operations executives at
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