Pharmacy & Therapeutics - October 2008 - (Page 612)

P&T SNAPSHOT: Managing Multiple Sclerosis Patients find difficulty in obtaining reimbursement for immunomodulatory drugs. Indicate for each of the following how soon you think your organization will adopt various benefit design strategies to deal with relatively expensive biotech-derived MS products. 80 69 60 50 44 % 40 27 22 20 23 18 16 9 0 Limit product Increase prescriptions annual out-of-pocket only to the appropriate maximums specialties Introduce a separate benefit design just for specialty therapies Require prior failure of a formularypreferred product before approving use of a nonpreferred product 39 45 40 35 30 29 22 12 12 20 32 26 42 29 32 38 59 75 Establish lifetime caps for injectable or specialty products Currently doing Will do within the next 12–18 months Will not do Create tiered Use Enforce strict coverage differential laboratory with prior value thresholds authorization significant (hemoglobin, rules to direct cost-sharing ESR, CRP, physicians to a differentials preferred etc.) as a (>$30) prerequisite agent within between a category preferred and for product access nonpreferred specialty therapies Create tiered coverage without significant cost-sharing differentials, but with strict prior authorization rules governing access to nonpreferred therapies Figure 1 Adoption of benefit design strategies to contain costs of expensive biotech drugs. CRP = C-reactive protein; ESR = erythrocyte sedimentation rate. (From The Multiple Sclerosis Trend Report.) Of the 63% of respondents who said they are currently taking an immunomodulatory drug, 22% are experiencing difficulties in obtaining reimbursement for these drugs, including: 50 Do you believe specialty pharmacies can add value to or enhance the ways in which MS specialists/neurologists deliver care to MS patients? 100 40 38 30 24 20 % 90 80 70 60 50 40 10 8 30 20 0 High copayment and/or deductible Other The drug required prior authorization by doctor The drug was denied 10 0 95 30 % 5 Yes No Figure 2 Difficulty of patients in obtaining reimbursement for immunomodulatory medications. (From The Multiple Sclerosis Trend Report.) Figure 3 Value of specialty pharmacies in delivering care for patients. (From The Multiple Sclerosis Trend Report.) 612 P&T® • October 2008 • Vol. 33 No. 10

Table of Contents Feed for the Digital Edition of Pharmacy & Therapeutics - October 2008

Pharmacy & Therapeutics - October 2008 Contents Editorial Medication Errors Prescription: Washington New Drugs/Drug News/ New Medical Devices Drug Forecast Medical Management of Parkinson’s Disease Why Is Health Care Regulation So Complex? The Next President’s Prescription for Action on Drugs Trends in Managing Multiple Sclerosis Product Profiler: Sancuso®

Pharmacy & Therapeutics - October 2008

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