Preparing for 2020 Specialty Drug Spend

For most of us, the end of the year is a time of reflection. But it is also a time for thinking ahead and thinking anew.

At Abarca, we very deliberately take the fourth quarter of the year to assess what we have learned and find new, better ways to apply it. For a pharmacy benefit manager, few aspects of our operations require this kind of careful thought and planning more than managing specialty drugs.

Specialty drugs are used to treat complex and chronic conditions, like cancer, multiple sclerosis, and rheumatoid arthritis. They are also among the most expensive drugs on the market, and have significant financial implications for PBMs, health plans, and the patients that rely on them.

To manage specialty drug spend, we consider a variety of factors, including:

  • Therapeutic alternatives: Are there other treatment options that might be preferable or more effective?
  • Volume: How prevalent is the disease among our members? Is the duration of treatment short or does it require a longer commitment?
  • Value-assessment: Is this therapy cost-effective based on the total cost of care and alternatives for a patient?
  • Disease-specific: How easy is it to diagnose the condition? What is the prognosis for patients—is it curable or chronic?
  • Prescriber-specific: Does the medication require a prescriber of a specific specialty? Is additional training needed for a prescriber to administer the treatment?

While there is no exact science for determining drug spend, we believe that proactive analysis and an understanding of our members are vital to being successful in this process.

At Abarca, we are continually challenging ourselves to find a better way—and our approach to specialty drug spend is no different. With Darwin, we can leverage real-world data to gain insight into patient adherence, engagement, and outcomes within treatment plans. This information is invaluable, and can help decrease costs for patients, not to mention saves lives.

As we prepare for next year’s specialty drug spend, we do so with careful consideration, unmatched analytical capabilities, and a mission to provide patients with the best treatment options possible.

This blog was written by Ana Rivera, PharmD, Senior Clinical Client Advisor at Abarca, based on sessions she attended at AMCP NEXUS

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