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April 4, 2019

Managing the Expanding and Expensive Specialty Drug Market

Specialty medications are revolutionizing the pharmaceutical industry, providing viable treatment options for complex conditions like multiple sclerosis, hepatitis C and cancer. However, these exciting new therapies come with a hefty price tag, costing 18 times more than traditional brand drugs and 189 times more than generics.[1] Additionally, due to the complex nature of the conditions specialty drugs treat, not all medications have the same level of effectiveness for each patient, and there can be severe side effects or other complications if the treatment is not managed appropriately. A thoughtful approach that focuses on the patient’s unique condition and balances clinical effectiveness, economic impact and the patient experience leads to better outcomes for the patient and the plan.

A Strategic Approach Helps Optimize Specialty Medications

As a URAC-accredited specialty pharmacy, EnvisionSpecialty has developed a care model that focuses on four strategies to achieve optimal outcomes, both for the plan sponsor and the patient taking specialty medications.

  1. Condition-Focused Clinical Controls: The complexity of specialty medications and the diseases they treat require a customized clinical approach. As an example, there are six different genotypes for hepatitis C and not all medications treat every genotype, nor are all drugs a good fit. Alcohol consumption and other high-risk behaviors can impact hepatitis C treatment as well and needs to be monitored. There are also a number of medications to treat multiple sclerosis, however, due to the complexity of the disease, not all patients respond the same to therapy. Understanding the unique characteristics of these conditions and the available treatments, while providing a tailored approach to care is imperative to achieving the best results.
  1. Individualized Care: Our specially trained pharmacists work with patients before the first dose of medication is even taken and continue to monitor and engage the patient throughout treatment. Before shipping the first dose, we educate the patient on their treatment and what to expect, determine the optimal time to start therapy and their readiness to begin the treatment regimen. We also assess patients for copay assistance through our SpecialtyBridge program, which helps link patients to copay support programs to make expensive medications more affordable and increase adherence. Throughout the course of treatment, our pharmacists routinely monitor patients’ progress, resolving any barriers or issues with their therapy.
  1. True Integration: EnvisionSpecialty fully integrates with plan sponsors, prescribers and pharmacy benefit managers to ensure proper coordination of care. On average, a patient with one chronic condition sees four doctors per year, while those with five or more may see 14 different providers a year.[2] This could lead to patients leaving the doctors’ offices with multiple prescriptions and filling them at different pharmacies. True specialty pharmacy integration can eliminate care gaps and provide better outcomes. Research shows that poor care coordination raises chronic disease costs by $4,500 per patient.[3] By sharing data and working together as a team, we can help control costs and improve care.
  1. Meaningful Data: Raw data can provide numbers regarding outcomes, but real insight comes from taking action to reduce costs and close care gaps like abandonment, disease progression and incorrect dosages. We provide robust reporting, insights and recommendations to identify risks and cost-saving opportunities, close gaps, and tailor patient communication and support.

EnvisionSpecialty’s dedication to the patient is the difference between simply supplying a medication and truly impacting the quality of a patient’s life. Knowing that every patient’s story is unique, we provide a proactive, hands-on pharmacy approach that is disease and drug specific, as well as tailored to each patient’s individual needs. Our care model ensures effective management of specialty drugs and the patients who depend on them. This proven program drives optimal outcomes by ensuring patients get the right medication, at the right time and the right cost. 

[1] Frandsen, Joynt, Rebitzer et al. (2015). Care Fragmentation, Quality and Costs Among Chronically Ill Patients. American Journal of Managed Care.

[2] Vogeli et al. (2007) Multiple Chronic Conditions: Prevalence, Health Consequences, and Implications for Quality, Care Management, and Costs. Journal of General Internal Medicine.

[3] Frandsen, Joynt, Rebitzer et al. (2015). Care Fragmentation, Quality and Costs Among Chronically Ill Patients. American Journal of Managed Care.

PAYERS
Learn how our approach to specialty medications saves money while improving outcomes.

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PRESCRIBERS
Find out how our care model can help optimize treatment for patients receiving specialty medications.

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