Biotechnology Healthcare - September/October 2008 - (Page 44)

SPECIALTY PHARMACY out, those that can show value are easy for health plans to embrace, but the bar is being set higher as the cost of specialty pharmaceuticals rise. Health plans are trying to stretch dollars every which way, and throwing money at providers of value-added services that cannot prove their value is not even close to being good enough. “You have to be able to show them that you can deliver on your promises,” Grupp says. “When there were only a few biologics on the market, people noticed, but the amount was small and it wasn’t taken that seriously. But as soon as the pipeline grew exponentially, the conversations changed. Unless you can validate that a diagnostic test was given, or that a patient is growing on a growth hormone, or that a patient received four vials of a drug last month as opposed to the five the patient was supposed to get, it’s very hard to determine that your service is justified.” Grupp points to the push by health plans to get data from providers of value-added services that compare biologics in the same or competing classes for treatment of a specific condition. Health plans have asked her to develop mechanisms that stratify disease progression and patient compliance on such drugs as the infusible agents given to RA patients. The data she turns over is not as scientific as a clinical trial, but can be used to differentiate products. Today’s data-driven focus is hardly a fad. With more and better ways to manage the health of patients who need specialty pharmaceuticals, Shurney says providers of valueadded services must invest heavily in technology that allows them to gather comprehensive data on every patient. “People are very mobile today, and it’s hard to contact them by phone. You have to have technology that reaches members wherever they are,” Shurney says. “That could mean working with device manufacturers to transmit data on a real-time basis. It could mean a device that records lab values and transmits them to a call-center nurse. It could mean automatic prompts sent to a patient’s cell phone. There is a lot of options, and a lot of smart people are doing a lot of innovative things. “But the bottom line is that you have to find ways to generate data showing that your services work in the most costeffective way possible. That’s the name of the game.” Scott Kober is a freelance writer in Philadelphia specializing in medical issues. The rationale behind value-added services Rheumatoid arthritis is one of the primary medical conditions for which value-added services could reduce utilization costs. Here are the costs of the six FDA-approved biologics for the treatment of RA. Product Abatacept (Orencia)a Dosing schedule Cost/dispensing unit Cost/patient/year ($) 100 kg: $20,210 $6,585 500 mg ( 100 kg) every 4 weeks 1000 mg in IV infusions twice, given 2 weeks apart $1,646/50 mL vial (10 mg/mL injection 50 mL vial) $688/2 single-use syringes (40 mg/1 mL syringe) Rituximab (Rituxan) Adalimumab (Humira) 40 mg every other week 40 mg weekly Anakinra (Kineret) Etanercept (Enbrel) 100 mg once daily 25 mg twice weekly 50 mg once weekly Infliximab (Remicade)b 3 mg/kg once every 8 weeks 10 mg/kg once every 8 weeks $8,941 $17,881 $824/28 single-use syringes (100 mg/1 mL syringes) $360/4 SDV (25 mg/vial) $720/4 SDV (50 mg/vial) $393/20 mL vial (100 mg/20 mL vial) $393/20 mL vial (100 mg/20 mL vial) $10,718 $9,362 $9,362 70 kg: $10,606-$14,141 70 kg: $24,747-$28,282 SDV=single-dose vials. aCosts include infusion at weeks 0, 2, 4, 8, 12, 16, 20, 24, 28, 32, 36, 40, 44, 48, and 52: 100 kg=4 vials. bCosts include infusion at weeks 0, 2, 6, 14, 22, 30, 38, 46, and 54; 3 mg/kg: 70 kg=3–4 vials; 10 mg/kg: 70 kg=7–8 vials. Source: National PBM Drug Monograph Abatacept (Orencia) 2006 44 BIOTECHNOLOGY HEALTHCARE · SEPTEMBER/OCTOBER 2008

Table of Contents Feed for the Digital Edition of Biotechnology Healthcare - September/October 2008

Biotechnology Healthcare - September/October 2008 Openers Editorial/David B. Nash, MD, MBA Contents At a Glance: Multiple Sclerosis Drug Track Personalized Medicine Healthcare Reform’s Effects on Biologic Access Breast Cancer Status Testing: A Crapshoot With Deadly Odds Trends, Issues, and Perspectives In the Management of MS So High-Tech, Yet So Simple The Evolution of Ascertaining the Value Proposition Specialty Pharmacy Employer to Employer Health Plan Confidential Trends

Biotechnology Healthcare - September/October 2008

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