Biotechnology Healthcare - September/October 2008 - (Page 45)

EMPLOYER TO EMPLOYER Peeling Back the Onion John Carroll, Senior Contributing Editor I n some respects, the University of Michigan makes specialty drug costs. There are biosimilars within some for an ideal laboratory to study how to manage drug specialty classes, such as growth hormones. Other counbenefits. In addition to covering 86,000 lives as a tries have approved biosimilar growth hormones, whereas major employer in the state — funding $70 million the United States does not have a process for biosimilar worth of drugs through almost a million prescriptions drug approvals. With considerable cost to be saved, each year — the university also has a rich resource of reshouldn’t the most cost-effective biosimilar be positioned searchers and medical staff who are willing and ready to in a preferred spot on the formulary? plumb the depths of therapeutic intentions and realities. “Until these issues are resolved, most health plans and “We use an evidence-based decision-making approach,” employers will concentrate on clinical guidelines, prior ausays Keith Bruhnsen, assistant director of benthorization, therapy management, and disease efits and manager of the prescription drug plan. management in handling the specialty drug benAnd he rattles off a long list of drug strategies: efit,” she continues. “The university’s drug plan prior authorization, step therapies, dose optiis in a unique position with the ability to partmization, pill-splitting, and so on. ner with the university’s health system to lever“We use FDA-approved dosing for guidelines age better drug purchasing. We will take adon quantity, supply, and appropriate use indicavantage of this strategy when possible.” tions,” says Bruhnsen, “which helps to address Cornish and Bruhnsen do have help, though. off-label and under- or overuse, approving paySXC Health Solutions provides software and ment for drugs [only when they] are appropriate “It’s like invesprofessional support services to the university. for the use.” And it’s all done as part of an un- tigative reportThe claims processor “codes in all of the plan wavering mission: providing “the right drug in ing,” says Keith design, utilization programs, and edits we use,” the right amount at the right time.” says Bruhnsen. Bruhnsen, when That mission is becoming ever more critical it comes to trackWhat sets the university apart is its ability to as costs associated with specialty drug use have ing unusual utitap researchers and medical staff to draw the line stubbornly resisted every effort to hold the line. lization patterns. between myth and reality when it comes to the “Our specialty drug trend is currently at 12 drug benefit. percent,” says Bruhnsen. “The main driver is in“As an academic medical research center, we gredient cost, as we have seen the cost for the average 30have supported several research programs,” Bruhnsen day supply increase by nearly 9 percent over the last six says. One project looked at tablet splitting with cholesterol months, while utilization has increased 4 percent.” drugs and found it safe and effective. “By encouraging staff, faculty, and retirees to split their statins, they were FOCUS ON GOOD SCIENCE able to save [patients] half of their copayments, and we About a year ago, Bruhnsen got some added help on the saved half on the ingredient cost, as the drugs cost the same drug management front when the university hired Laura regardless of dosage. Participants in the university’s reCornish, PharmD, to help manage the specialty drug bensearch said it was no big deal to make sure they were splitefit. ting their meds properly.” “We’re trying to treat the specialty drug classes like we Another recently completed study is undergoing data do any of the other drug classes,” notes Cornish, citing use analysis. This study was designed to measure the changes of such techniques as preferred-drug programs, step therin patient adherence against reductions in copayments. apy programs, and quantity limits, when trying to manage “The emphasis is to get the patients to take their medicacosts. But to her chagrin, a major cost-management tool tions. We believe that many do not take the whole comis not at her disposal. At least, not yet. plement of medications that are prescribed,” Bruhnsen “As there are few or no generics available in the spesays, most likely because “financial barriers are a disincialty drug classes, some of these options, such as precentive to compliance.” ferred products, may be of limited value in managing “Generic medications for diabetes have copayments SEPTEMBER/OCTOBER 2008 · BIOTECHNOLOGY HEALTHCARE 45

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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