Getting the most out of specialty pharmacy management

Looking at the big picture, specialty pharmacy management with medical benefits helps manage costs and health. Dr. Richard Weininger explains the importance of specialty medications, and how a comprehensive Specialty Pharmacy and Medical plan can drive better health and better savings.

“You want to ensure specialty pharmacy is managed holistically by combining it with your medical plan.”
-Dr. Richard Weininger

There's been an explosion of modern drug therapies over the past decade. These new therapies have ushered in an era of optimism for a variety of debilitating, life-threatening chronic diseases. In fact, many of these new therapies have changed the course of disease and health outcomes for thousands of patients.

However, along with the promise of better symptom and disease control, these new medications can bring a host of increasingly complex clinical and economic issues. How we choose to monitor and manage these issues is critical.

The successful management of specialty medications depends primarily on engaging knowledgeable professionals. It's crucial that these professionals are available to dispense, advise and monitor the utilization of drugs that have complex indications and multi-system toxicities. I believe that the safe dispensing of many injectable and oral medications is often best managed by professionals who are specially trained.

It's important to understand all aspects of specialty pharmacy management, such as health coaching, lab work and associated medical costs. For example, when specialty pharmacy benefits are aligned with the medical plan, it allows doctors to provide patient care in an environment that's right for the patient. It eliminates any plan provisions that force patients to go to an alternate location for administration of their specialty medication, and allows doctors to administer medication wherever it's most cost-effective and convenient for the patient.

Although these diseases affect less than two percent of the population, 60 percent of individuals taking specialty medications have at least one other chronic condition that is treated with medication. Working with a specialty pharmacy manager that is part of the patient's medical plan provides a central source for the patient's health information. Patients are able to receive health advocacy and coaching while working collaboratively with their physician to maximize treatment and care.

Specialty pharmacies distinguish themselves by engaging and training staff with a specific in-depth knowledge of drugs. These include drugs that treat cancer, immunologic disorders, arthritis, genetic deficiency diseases and other illnesses. They bring skills to the dispensing of these medications that provide exceptional added value, both clinically and economically. From a clinical point of view, they ensure that members receive current drug-related information, reduce toxicity risk through smart dialogue, and employ management programs to help measure drug utility. Because this complex area is best managed by specially-trained professionals, it's also best managed when all incentives are aligned to benefit the patient, plan sponsor and physician.

You want to ensure specialty pharmacy is managed holistically by combining it with your medical plan. With the medical and pharmacy benefits together, patients can receive integrated care that is cost effective. In addition, physicians are better aligned with a health plan that meets their needs. Working with one organization helps manage drug costs, ease drug administration and provides patients with seamless care to maximize their safety and well-being.     

In an era of modern, complex drug administration and rising costs, the role of effective, efficient specialty pharmacy managers has never been more important. Savings, as measured by improved quality of life and safe administration, are the hallmarks of successful specialty pharmacy interventions.  If managed well and holistically, plan sponsors can be confident that cost, employee productivity and quality of life are being optimized. All without compromising care and communication between the patient and physician. 

About

Dr. Richard Weininger is a board-certified hematologist and oncologist with more than 20 years' experience in managed care. He is the executive vice-president for corporate strategies at CareCore National, LLC. In that role he has overall responsibility for managed programs in medical and radiation oncology.