Integrated Pharmacy Benefits for Specialty Pharmaceuticals: Access and Management. Over the past five to 10 years, specialty drugs have driven the rising expenditures for all pharmaceuticals. Pricing issues aside, the availability and use of specialty drugs is a key driver of growing medical spend in commercially insured populations.
As these products become more the norm for treatment of chronic conditions in various patient populations, they also become associated with the growing trend in the overall total cost of care increases that include diagnostics and devices along with provider professional fees.
Specialty pharmacy or provider dispensing and management of these drugs include particular handling, medication adherence and monitoring, limited or restricted distribution, and increased collaboration with other health care providers compared with the dispensing and management of nonspecialty drugs in a local community pharmacy.
- The differences between a specialty product and a conventional agent
- Specialty coverage basics related to medical and pharmacy benefits
- Specialty coverage in the context of risk
- Sites of care and specialty drug use
- The importance of related medical devices and/or diagnostics
- Generalities about the interdependency of marketplace stakeholders, and risk drivers of coverage
- Trends or issues for benefits coverage of specialty drugs
- Current trends and strategies (including regulatory) plus a crystal ball view on the marketplace and future coverage into the next decade
Our previously published Glossary of Common Drug-Related Benefit Terms & Acronyms and Pharmacy Benefits for Nonspecialty Drugs: Access and Management provided general information, pharmacy benefit insights and trends, and common drug-related terms and acronyms that apply to both pharmacy and medical benefits. However, neither focused on specialty drugs as a key responsible driver of the economic trend in modern medicine and total health care costs, especially for chronic conditions.