Humana Happenings

A periodic feature highlighting news and information from our administrative partner, Humana. Submitted by James J. Wisniewski, R.N. – BSN, Strategic Consultant – Humana Pharmacy Solutions

Specialty pharmacy therapies are here to stay

I used to think my grandmother was pretty lucky. She saw an unprecedented explosion in technology in her 70 or so years on this earth. When she was born the typical mode of transportation was the horse and buggy and she lived to see the first man on the moon. As amazing as that sounds, the pharmaceutical advances we’ve seen in the last 20 years or so in the treatment of chronic, debilitating and life-threatening diseases seemingly dwarfs Mr. Armstrong’s historic steps on the lunar surface. I’m talking about the appearance and startling rise of specialty pharmacy therapies in the realm of today’s medical treatment.

Although no formal definition of specialty pharmacy exists, it is generally agreed upon that these products share the following characteristics:

  • High cost
  • Require special handling
  • Treat rare diseases
  • Distributed through limited channels
  • Require ongoing assessment of response to therapy
  • Require monitoring of side effects
  • Special patient teaching is needed

The health conditions most benefiting from the development of specialty pharmacy therapies include:

  • Multiple Sclerosis
  • Rheumatoid Arthritis
  • Psoriasis
  • Crohn’s Disease
  • Hepatitis C
  • Hemophilia
  • Cancer

Unlike the drugs of my grandmother’s generation, the manufacturing of these new treatments involves a highly scientific and complex process. It’s this very expensive process that in large part drives the alarming cost of these treatments. The benefits and insurance literature are replete with articles from experts on the current and future costs of these new treatments. Payers will see the specialty pharmacy component of their drug spend increase by about 20 percent per year. This year specialty pharmacy will account for less than one percent of all prescriptions taken by members, but make up about 25 percent of the pharmacy benefit cost! Costs are expected to rise to over 30 percent in the next year or so.

Specialty pharmacy therapies are here to stay. The development of these treatments has led to an amazing improvement in the quality of life and overall productivity of the people afflicted with these heretofore nearly hopeless diseases. We will continue to see tremendous therapeutic advancement and cost increases in the coming years. Cost control, appropriateness and coordination of treatment are all things your pharmacy benefit manager (PBM) should be well-equipped to assist with.

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