A Healthesystems publication

Fall 2014
Specialty Pharmacy Medications: Drug Innovations Offer Great Promise at High Cost

The growing presence of specialty medications within workers’ compensation introduces a new set of complexities to medication management. Careful patient selection will contain costs while ensuring appropriate care; however, the limited clinical experience surrounding these novel agents will make it difficult to weigh potential benefits against cost. 

The workers’ compensation industry is already seeing some instances of specialty pharmacy treatments in limited patient populations. As this segment of the pharmaceutical industry continues to evolve, it is becoming even more important for payers to develop proactive strategies to monitor the appropriate use of these costly medications. A precautionary yet strategic effort to address specialty medications can better equip workers’ comp payers to manage future and ongoing research and development, as evidenced by the large number of specialty drugs in the medication pipeline.

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1 -Wall Street Journal. Rockoff JD. Drug Makers See Profit Potential in Rare Diseases. January 30, 2013. Available at: http://online.wsj.com/articles/SB10001424127887323926104578273900197322758 . Accessed 10/26/14.
2 -IMS Institute for Healthcare Informatics. The Global Use of Medicines: Outlook through 2017. Available at: http://www.imshealth.com/portal/site/imshealth/ menuitem.762a961826aad98f53c753c71ad8c22a/? vgnextoid=9f819e464e832410VgnVCM10000076192ca2RCRD& vgnextchannel=a64de5fda6370410VgnVCM10000076192ca2RC RD&vgnextfmt=default . Accessed 10/26/14.
3 -Specialty Trend Management: Where to Go Next. Insights 2013. CVS Caremark. CVS Caremark projection (2013) based on internal data and forecasts; McKinsey MPACT6 Model, Kaiser Family Foundation: Medicare at a glance, 2012; National Health Expenditure Projections 2011-2021 CMS; Avalere 2013 Medicaid Opt-Out Model, Milliman Specialty Medication Benchmark Study developed using the 2010 and 2011 Truven Health MarketScan Research Database for a commercial population (used for 2012 estimate).
4 -Pharma. The Biopharmaceutical Pipeline: Evolving Science, Hope for Patients. Published January 17, 2013. Available at: http://www.phrma.org/sites/default/files/pdf/phrmapipelinereportfinal11713.pdf . Accessed 10/26/14.
5 -U.S. Food and Drug Administration Regulatory Information. Frequently Asked Questions: Breakthrough Therapies. Available at: http://www.fda.gov/regulatoryinformation/legislation/federalfooddrugandcosmeticactfdcact/significantamendmentstothefdcact/fdasia/ucm341027.htm . Accessed 10/26/14
6 -Pollack, Andrew. The New York Times. FDA Approves Pill to Treat Hepatitis C. December 6, 2013. Available at: http://www.nytimes.com/2013/12/07/business/fda-approves-pill-to-treat-hepatitis-c.html . Accessed 10/26/14.
7 -Pollack, Andrew. NY Times. July 23, 2014. Gilead’s Hepatitis C Drug, Sovaldi, Is on Pace to Become a Blockbuster. Available at: http://www.nytimes.com/2014/07/24/business/sales-of-hepatitis-c-drug-sovaldi-soar.html . Accessed 10/26/14.
8 -Study predicts hepatitis C will become a rare disease in 22 years. 4 August 2014. http://scienceblog.com/73746/study-predicts-hepatitis-c-will-become-rare-disease-22-years/#ZFVWPplGSiFU3Ckq .97 Accessed 14 September 2014
9 -Gilead Sciences Policy Position. Gilead Sciences, Inc. Innovating and Expanding Access to Hepatitis C Treatments. October 2014. Available at: http://www.gilead.com/~/media/Files/pdfs/Policy-Perspectives/ExpandingAccesstoHCVTreatments10214.pdf . Accessed 10/26/14.
10 -Pollack, Andrew. Harvoni, A Hepatitis C Drug From Gilead, Wins, FDA Approval. New York Times. October 10, 2014. Available at: http://www.nytimes.com/2014/10/11/business/harvoni-a-hepatitis-c-drug-from-gilead-wins-fda-approval.html . Accessed 10/26/14.
11 -Specialty Trend Management: Where to Go Next. Insights 2013. CVS Caremark. CVS Caremark Internal Data, 2013. Available at: http://info.cvscaremark.com/sites/default/files/Insights%202013.pdf . Accessed 10/26/14
12 -Healthesystems. Medical Applications of Specialty Drugs in Workers’ Compensation. RxInformer. Spring 2014 issue. Available at: www.healthesystems.com/rxinformer . Accessed 10/26/14.
13 -Demaria, Acelajado MC, Luck J, et al. Variations and Practice in the Care of Patients with Rheumatoid Arthritis: Quality and Cost of Care. J Clin Rheumatol. 2014; 20(2): 79-86. Available at: http://www.medscape.com/viewarticle/821539 . Accessed 10/26/14.
14 -Medicines In Development: Arthritis A Report on Arthritis and Related Musculoskeletal Diseases. PhRMA. 2014 Report. Available at: http://www.phrma.org/sites/default/files/pdf/2014-meds-in-dev-arthritis.pdf . Accessed 10/31/14.
15 -Brown MT, Bussell JK. Medication adherence: WHO cares? Mayo Clin Proc. 2011;86(4):304-14.
16 -Bangsberg, Charlebois, Grant, Holodniy, Deeks, Perry, et al. AIDS. 2003; 17(13). Available at: http://www.medscape.com/viewarticle/460684 . Accessed 10/26/14.
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