Cost & Access, Specialty Medication

Insights: Specialty Trend Management

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According to an Insights report from CVS Caremark, specialty drugs are having a growing impact on the nation’s health care costs. The report, Specialty Trend Management – Where to Go Next, examines specialty drugs, which treat complex diseases, such as multiple sclerosis, rheumatoid arthritis, hepatitis C and cancer, and takes an in-depth look at ways to manage the cost of these medications. Although only a very small percentage of patients (less than four percent) use specialty medications, they account for 25 percent of health care costs.

New CVS Caremark Report on Specialty Pharmacy

The report reviews foundational strategies for managing specialty drug trend and then provides additional insights into three key areas where CVS Caremark offers expanded services to improve cost savings for clients. These include:

Opportunities for Significant Costs Savings

The report shows that clients providing coverage for populations of one million could save up to $38 million in 2014 across five high-spend therapeutic categories (hemophilia, intravenous immunoglobulin (IVIG), oncology, auto-immune diseases and multiple sclerosis) by implementing CVS Caremark’s comprehensive management strategies for specialty drugs. 

Understanding the Cost Impact of Site of Care

Many specialty drugs for the treatment of conditions such as cancer, rheumatoid arthritis and multiple sclerosis are administered via infusion that can take place in a hospital, physician’s office, infusion center or even the patient’s home. Costs for both the drug and its administration can vary by thousands of dollars depending on where the patient receives the infusion.  CVS Caremark offers programs that can help payers increase the utilization of more cost-effective sites of care for infused therapies.

Site of Care Playing a Role in Increasing Specialty Pharmacy Costs

Spanning the Pharmacy and Medical Benefit: Nearly half of specialty drug spend actually occurs under the medical benefit rather than the pharmacy benefit, where it can be harder to track and manage using clinical and cost management strategies.  CVS Caremark offers clients management techniques to help capture and control spend billed under the medical benefit.