Managed Care - July 2008 - (Page 24) Payers Struggle to Ensure High Level of Adherence To Costly Specialty Drugs Use of aggressive techniques to encourage patient adherence saves and improves lives and controls costs “Some of these products offer lifesaving and quality-improving benefits,” says John Watkins, pharmacy manager for formulary development at Premera Blue Cross in Mountlake Terrace, Wash. ormer surgeon general C. Everett Koop, “The principal challenge facing public and private MD, famously said “Drugs don’t work in payers relates to affordability of these products.” patients who don’t take them.” This is exAt Kaiser Permanente in California, biotech ceptionally true, with potentially terrible products have greatly increased drug costs, particconsequences, of specialty medications. ularly in oncology, rheumatology, neurology, en“Medication adherence is particularly impordocrinology, and dermatology, says C. Douglas tant for people who have [the severe] conditions Monroe, RPh, a drug information pharmacist that require the use of specialty medications,” with Kaiser Permanente Drug Information says Thom Stambaugh, RPh, vice president Services. “Some conditions that were forand chief pharmacist for Cigna HealthCare. merly untreatable now have a single, very “We work with the member and physicians to costly treatment available. For example, make sure medications are taken as preKaiser Permanente in California spends more scribed.” than $10 million annually for biotechThese are often astronomically expensive derived enzyme replacements to treat apmedications. The average prescription cost proximately fifty patients with various rare, for these medications runs more than $1,500 inherited enzyme deficiencies that result in and some top $100,000 a year, according to Our approach Express Scripts, a large pharmacy benefit “integrates med- severe health problems and early mortality. For these patients, there are no lower-price almanagement company. Specialty-drug ical, pharmacy, ternatives.” spending in this country could reach $99 bil- and behavioral health care,” says Kaiser Permanente is an integrated health lion by 2010, nearly double the $54 billion Thom Stamsystem, and therefore “medication adherence spent in 2006. baugh, RPh, vice is viewed as a responsibility of all care proThe cost of specialty drugs, including president of biotech drugs, is related to the advances in re- Cigna HealthCare. viders, working in as coordinated a process as possible,” says Monroe. search, technology, and design that created “Our providers have immediate access to pharthem, and to the complexity of the treatment asmacy records, and for these critical and expensive sociated with their use. Many specialty drugs redrugs, adherence can be monitored through claims quire patient-specific dosing and careful clinical records. The same techniques of measuring adhermanagement. Many are administered by injection ence through refill rates and lab tests used for or infusion. Some patients inject themselves; othstandard drugs are now starting to happen with ers receive their drugs at a physician’s office or outspecialty drugs, led by our ambulatory pharmpatient clinic or through a home care service. Sevacists.” eral newer specialty drugs, particularly those for Adherence to (or compliance with) a medication oncology patients, are taken orally. By Martin Sipkoff Contributing Editor F 24 MANAGED CARE / JULY 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.