Specialty medications are a concern for most payers, as this growing segment is expected to account for half of all drug spend by 2020, even though they’re only used by 1% to 2% of the population. Inflammatory conditions, including rheumatoid arthritis, plaque psoriasis and Crohn’s disease, represent one of the top categories for specialty drug spend. Specialty medications used to treat inflammatory conditions cost an average of $5,000 for a 30-day supply and can be as much as $10,000 per month. However, these revolutionary therapies can greatly improve the quality of life for the patients who take them.
In addition to the high cost, adherence to inflammatory treatments can be difficult, even though it is critical for achieving optimal outcomes. Whether due to side effects, injection fatigue or simply forgetting to take the medication, if a patient is not adherent, their condition worsens and the cost of the pricey treatment is wasted. A specialty pharmacy that provides individualized care, offering education on the condition and treatment, monitoring progress, and intervening where needed, can overcome these hurdles and get the most out of a specialty therapy for both the patient and the payer.
Simple Diet Change for Patient Saves Plan Nearly $5,000
While monitoring the treatment of a patient with Crohn’s disease, an EnvisionSpecialty pharmacist learned that the individual was experiencing nausea while taking her specialty medication. Additionally, as the medication is an injectable, the patient also expressed having a site reaction after each injection. “In talking with the patient, we discovered that her diet could be the cause of her discomfort,” explained Misty Willard, director specialty pharmacy for EnvisionSpecialty.
Certain foods trigger Crohn’s disease symptoms, such as spicy and greasy meals. Alcohol, fiber, gluten and dairy should also be limited. The pharmacist helped with a diet plan and also suggested rotating the injection site to avoid reactions. “Thanks to the suggestions we provided, the patient is no longer experiencing nausea or having difficulty administering the medication,” Willard commented. “Because of this, she has not had to miss additional time at work and has expressed greater overall job satisfaction. She has continued with her treatment, saving $4,853 by not wasting the medication, and improving her condition.”
Low-Cost Vitamins Lead to Almost $3,000 in Plan Savings
A rheumatoid arthritis patient was experiencing frequent muscle cramps and spasms while taking his specialty medication. He discussed this with one of our pharmacists during our regular monitoring communications. The pharmacist encouraged the patient to keep taking the medication and recommended adding vitamin supplements to help with the muscle cramps, as well as discussing the issue with his physician.
Deficiencies in potassium, calcium or magnesium can lead to muscle spasms and cramps. Proper hydration is also important. These recommendations solved the problem. The patient is no longer experiencing muscle cramps and spasms and his condition has improved with the medication. By continuing with the treatment, $2,851 worth of drugs did not go to waste and the patient’s quality of life improved.
Optimizing Care and Costs
These patient stories demonstrate the need for a highly engaged specialty pharmacy that provides ongoing monitoring and support. With our comprehensive care model, our specially trained pharmacists work with inflammatory patients before they even take their first dose of medication, ensuring they know what to expect, have the support they need and start therapy at an optimal time. We continue to monitor and track their progress throughout treatment, intervening when needed to provide optimal results. With a growing pipeline of pricey specialty medications, including for the treatment of inflammatory conditions, a highly engaged specialty pharmacy, like EnvisionSpecialty, can help control costs while improving outcomes for the patient and the payer.
 2018 Trends in Specialty Drug Benefits, PBMI.