Employers who provide their employees the use of such drugs are implementing specialty pharmacy programs.
Smart Business spoke with Steven Marciniak, R.Ph. and director of pharmacy programs for Care Choices, about the importance of specialty pharmacy to employers.
What are the differences between specialty pharmacy and traditional pharmacy?
Specialty pharmacy typically consists of injectable medications that are very expensive. These medications average $1200 to $1500 a month per patient as opposed to traditional medications, which average from $50 to $55. Conventional medications are studied to see if there is a healing affect on an aliment. Specialty drugs are designed, created and built to treat a specific illness such as multiple sclerosis, rheumatoid arthritis and Hepatitis C.
How does an employer or employee benefit from the specialty pharmacy program?
The program not only provides medications but also patient care and counseling.
Enbrel is a self-injectable drug used to treat rheumatoid arthritis. Under traditional pharmacy care, a doctor prescribes a medication for a patient to use until the next time he or she sees the patient. Prescription drugs are an expensive benefit provided to employees, therefore employers should have reassurance that their employees are being prescribed and using the best possible drug to treat their condition.
Specialty program provide follow-up care. In the case of a patient taking Enbrel, the doctor would prescribe the medication and submit the request to a specialty vendor. The vendor would make sure the patient has tried other possible treatments on the market. Then he or she would make sure the patient meets protocol requirements for each drug prescribed.
The specialty program will have a trained medical consultant contact the patient directly before their next refill. The consultant will inquire about the patient’s reaction to the drug, how he or she stores the drug and if he or she is using it properly. If everything meets the requirements, the consultant will submit the patient’s next prescription request. If there are problems, the consultant will get the patient the help needed. For employers, specialty pharmacy can reduce the cost of injectables.
What should employers look for in specialty pharmacy providers?
It is important for specialty pharmacy companies to work with physicians to design a specialty program. Employers should ask if the program is mandatory or voluntary for employees and if it includes both self-injectables as well as office-based injectables. The number of vendors the health plan uses is also a key factor. The more vendors used, the more confusion there may be in the marketplace.
How can an employer determine if specialty pharmacy is right for his or her company?
Illnesses that are advanced need advanced medicine. Specialty pharmacy drugs are going to become mainstream. Eventually, all employers will have employees that need this form of medication. Specialty pharmaceuticals only make up about 8 percent to 10 percent of the total amount spent on drugs. However, costs associated with specialty drugs are increasing at an average of 20 percent to 25 percent because numerous types of drugs now in the (Food & Drug Administration) pipeline will be approved over the next few years. In addition, several drugs already on the market are being approved to treat more aliments than originally designed.
Should employers work this plan into their budget and company?
It is important for employers to look at the long-term investment instead of the dollar amount. The key to the program is better patient care. Hepatitis C is a condition where patients have to take a medication for a period of time to potentially rid themselves of the condition. If someone were calling a patient with Hepatitis C every month to ensure he or she continues regular use and to guide the patient through the process, the patient is are more likely to finish the treatment successfully; therefore the employer would save money because the patient would not require more serious treatments in the future, such as a liver transplant. It is the long-term quality care component that makes this program better than more traditional programs. In the long run, it saves companies money because they improve the quality of the care and the patient compliance, therefore improving the condition of employees’ health.
STEVE MARCINIAK is director of pharmacy services for Care Choices, a nonprofit health care organization and a subsidiary of Trinity Health. Care Choices HMO is ranked No. 12 among 257 commercial plans nationwide and is the top-rated plan in Michigan, according to U.S. News & World Report/NCQA “America’s Best Health Plans, 2005.”