Business Magazine

What You Don’t Know Can Cost You

Posted on the 19 October 2011 by Billcookonline @billcookonline

Today’s post is a guest blog by our BioPlus President and CEO, Dr. Stephen Vogt.  He does a great job of explaining the tremendous value of specialty pharmacy and how it differs from a mail order pharmacy:

Posted by Dr. Stephen Vogt ⋅ October 17, 2011 ⋅

The majority of employers simply don’t understand the ins and outs of specialty pharmacy benefits, according to a new survey recently released by Midwest Business Group on Health (MBGH), a non-profit business group of private and public employers. The MBGH survey found that:

  • 53 percent of employers have only a moderate understanding of specialty pharmacy.
  • 25 percent of employers have little or no understanding of specialty pharmacy.
  • 70 percent do not know how much their company spends on specialty pharmacy medications through their medical or pharmacy plans.

Whether employers stick their heads in the sand or not, it doesn’t change the fact that specialty pharmacy is emerging as one of the fastest growing areas of health care spending. The medications and biologic products supplied by specialty pharmacies are used in the treatment of complex conditions, such as hepatitis C, multiple sclerosis, and rheumatoid arthritis. These medications come at a steep cost and generally require detailed instructions for correct dosing, assistance with serious side effects, specialized storage and distribution, and special approval for use.

Only 13 percent of employers are currently using a specialty pharmacy provider, with the rest relying on a traditional benefit design, including tiered formularies, copayments, and coinsurance for specialty drugs. Increasingly, specialty pharmacy is recognized as more appropriate for specialty medications since this model is value-based and can come with innovative benefit designs.

Every company’s human resources department and insurance purchaser simply must put specialty pharmacy on their radar screens; not doing so will cost you money. Consider the treatment of hepatitis C.

Hepatitis C treatment tallies up a bill of $60,000 to $80,000 per treatment. The treatment can cure up to 70 percent of patients with genotype 1 hepatitis C virus. However, this cure rate only applies to employees who take their medication correctly and complete the entire therapy protocol. I recently met with two state commercial payers. One stated they only had a 40 percent completion rate, while the other saw a dismal 4 percent completion of hepatitis C treatment! This leaves most of their hepatitis C patients untreated and at risk of very costly future interventions (including liver transplants and treatment for cirrhosis and liver cancer).

What accounts for these low compliance rates? I think the explanation lies with the fact that these payers had turned over what should have been a specialty pharmacy treatment to a PBM that treated the hepatitis C therapy like any other pill. The PBM simply got the script and shipped it out to the patients. This method is simply not appropriate for hepatitis C treatment’s potential side effects, adverse effects, lifestyle changes, drug interactions from other therapies, and pill volume. Hepatitis C treatment requires a different path. Without proper pharmacy management, the aforementioned method is doomed to fail.

At BioPlus, we do so much more than ask if the patient is ready for their next shipment. This is not in the mail-order pharmacy model. Here, each patient undergoes a pharmaceutical care consultation with a specialty Pharm.D., weekly evaluation to a plan of care, and has a team of encouragers to stay with the plan. Our results speak for themselves: over the past seven years we have recorded an 83-88 percent compliance rate for hepatitis C treatment. The evidence is clear; relying on expert care from BioPlus Specialty Pharmacy for hepatitis C treatment will cure more of patients and save employers money in the long run.

Stephen C Vogt, PharmD
President and CEO
BioPlus SP

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