Biotechnology Healthcare - September/October 2008 - (Page 46)

EMPLOYER TO EMPLOYER The university is about to launch a new data management effort that will track all therapeutics used under the medical, pharmacy, and dental benefits. Rising specialty pharma costs • The University of Michigan covers 86,000 lives at a cost of $70 million for prescription medications. • In January, specialty pharma accounted for 14.8 percent of that cost, and a 30day supply cost an average of $1,344. • In June, specialty pharma accounted for 16.9 percent of that cost, and a 30-day supply cost an average of $1,493. • This fall, the university is booting up a new data management effort that will track therapeutics used under the medical, pharmacy and dental benefits. University experts can review the data to see if new policies should be suggested pertaining to drug use. high-cost oral medications that are offered under the pharmacy benefit. Infusion products are covered under the medical benefit. And, at least for the short term, that’s where they will stay, with a considerable amount of thought and evaluation to occur before any changes are made. “It’s a matter of peeling back the onion,” says Bruhnsen. “So far we just haven’t looked [at the medical benefit], and sometimes drugs in the medical benefit are hard to get to.” But that is changing. This fall, the university is booting up a new data management effort that will track all therapeutics used under the medical, pharmacy, and dental benefits. “I don’t know how many employers have this luxury,” says Cornish. “It will afford an invaluable tool for a total therapeutics analysis. For example, the use of the database will assist us in evaluating specialty drug claims paid under the medical benefit; these evaluations are necessary before making any decisions to move drugs out of the medical benefit and into the pharmacy benefit.” Once the new system is up and running, says Bruhnsen, it will be easier to track unusual utilization patterns. “It’s like investigative reporting,” he adds. “You can go back and look at charts and see whether the utilization is appropriate.” The data can be reviewed by Bruhnsen and other researchers at the university who study the field to see if they suggest new policies on drug use. Staying informed about what’s coming up is an important part of the process, Bruhnsen and Cornish agree. But with a tidal wave of information rolling in from multiple sources, that’s not an easy task. “If there’s a potential blockbuster entering the market, then we’ll work with the pharmacy and therapeutics committee to determine if any utilization management programs are warranted,” says Bruhnsen. “The key is to stay ahead of the eight ball.” John Carroll is a freelance writer and is the editor of Fierce Biotech. reduced to zero, while preferred brand copayments were reduced by 50 percent and nonpreferred brands by 25 percent,” he says. “We believe that programs such as these have helped push our generic dispensing rate to over 69 percent.” There’s also a two-year drug management program underway that focuses on people who take nine or more medications. “They are given information on alternatives, some are given a phone consultation with a pharmacist, or a face-to-face consultation with a pharmacist at the university,” he notes. The university is looking for “good medical offsets and improvements in patient therapy. “These pharmaceutical management programs are applicable across the board if you have good science to show they work and are valid,” says Bruhnsen. And they all fit into the university’s evidence-based approach to managing biologics. GETTING MORE DATA ON DRUGS Five years ago, the university drug managers “started with isolating self-injectable medications in terms of coverage,” says Bruhnsen. “Since then, the use of those medications has grown. There are more oral and infused products in the specialty group. We are very concerned about the continued increased in utilization and cost. That’s why we brought Laura on board.” The specialty drug program covers self-injectable or Employer to Employer A regular column for healthcare purchasers Case studies of how employers, coalitions, and other purchasers approach the challenges of managing biologics. Send your story to Mike Dalzell, editor, at mdalzell@medimedia.com. 46 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

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.