AIS Health spoke with several industry experts about their expectations for management strategies and pricing of specialty drugs in 2018.
In terms of specialty drug management strategies, Martin Burruano and Amy Nash at Independent Health expect to see “increasing formulary management by disease stateâ€¦, preferred specialty drugs within therapeutic classes and value-based contracting with specialty partners.”
Programs that “manage drugs covered under the medical benefit in addition to those that may fall under both medical and/or pharmacy benefits” are likely to gain more attention, according to David Lassen at Prime Therapeutics LLC. He also predicts that payers will continue to look for means to better manage the specialty pharmacy expenditure across the medical benefit.
Thom Stambaugh, R.Ph., vice president for Cigna, suggests that integrated pharmacy and medical claims data will play a key role in determining the effective of certain drugs and avoiding unnecessary medical events.
President of PerformRx Mesfin Tegenu expects to see “a greater focus on outcomes-based contractingâ€¦[and] more comprehensive reviews/treatment algorithms for complex disease states.”
As the prices of specialty drugs have drawn a lot of attention in 2017, industry experts indicate that pricing will continue to be the front-page topic.
According to Burruano and Nash, specialty drug prices are likely to keep increasing. Meghan Oates-Zalesky of InCrowd sees the same trend, criticizing the current administration’s instability and “lack of consideration applied to the repeal of the individual mandate.”
Stephen Cichy of Monarch Specialty Group, LLC, expects more attention on specialty generics as well as a shift away from open specialty networks.
While less than 1% of the population in the United States accounts for one-third of total drug expenditures, the cost of certain therapies has contributed greatly to the unsustainability of the current health care model, Tegenu suggests. He points out that the key question is “how much are we, as a society, willing to pay for the benefits of certain drug therapies currently available and in development?”