Benefit Design Innovations to Manage Specialty Pharmaceuticals

Benefit design innovations to manage specialty pharmaceuticals.

BACKGROUND Spending on specialty pharmaceuticals is rising faster than that for traditional drugs. In 2006, specialty drugs were the largest category driving drug costs and utilization trends. Even with effective management, expenditures on these agents are projected to increase exponentially in the coming years. OBJECTIVE To review benefit design strategies used by payers to control costs an...

Opportunities and challenges of specialty pharmaceuticals.

The promise of specialty pharmaceuticals: are they worth the price?

BACKGROUND Specialty pharmaceuticals have evolved beyond their status as niche drugs designed to treat rare conditions and are now poised to become the standard of care in a wide variety of common chronic illnesses. Due in part to the cost of these therapies, payers are increasingly demanding evidence of their value. Determining the value of these medications is hampered by a lack of robust pha...

Specialty pharmacy networks for hospitals in the offing: absence of onsite access to specialty pharmaceuticals has care and financial implications.

Two competing hospital networks are assembling specialty pharmacy programs to satisfy drug manufacturers' requirements for delivery of costly, restricted distribution drugs to hospitals. Hospitals' inability to dispense such drugs can affect patient care and revenue.

Can HMOs manage the mental health benefit?