Specialty pharmacy may be one of the most rapidly rising costs in all of healthcare, but these costs are shouldered by a small percentage of patients. As such, it is essential that new innovative payment models be developed for these new products, said Steve Miller, MD, senior vice president and chief medical officer of Express Scripts.
Specialty pharmacy may be one of the most rapidly rising costs in all of healthcare, but these costs are shouldered by a small percentage of patients. As such, it is essential that new innovative payment models be developed for these new products, said Steve Miller, MD, senior vice president and chief medical officer of Express Scripts.
Transcript (slightly modified)
What are the opportunities and challenges facing specialty pharmacy over the next few years?
Yeah, so specialty is actually one of the most rapidly rising costs in all of healthcare. Right now you have about 1% to 2% of patients spending about 30% of the pharmacy dollars; by 2018 that grows, that 1% to 2% of patients will be spending 50% of the pharmacy dollars. And so it’s an enormous strain for all, both patients but also plan sponsors. So specialty pharmacy is going to be central to pharmacy for the next several years, and it really is the hot topic.
How will specialty pharmacy be impacted by innovations in our healthcare system?
There are several ways to think about that. One is innovations in new technologies and so when you look at the drug pipeline, almost the entire pipeline is devoted to specialty drugs. And so you’re going to see more and more drugs coming into the marketplace, but almost all of them are going to be specialty drugs. The second way you got to think about innovation is how we’re going to pay for these drugs. Historically, you had cancer chemotherapy at $10,000; for chemotherapy it’s now over $100,000. You have gene therapy that’s going to be entering the market in the next several years and that’s going to be over a million dollars, and so not only are we going to have innovative new products but we’re going to have to come up with innovative new models to pay for those products.
Dr Dalia Rotstein: Physicians Must Be Aware MS Affects People of All Backgrounds
April 24th 2024Dalia Rotstein, MD, MPH, emphazises the importance of awareness that multiple sclerosis (MS) impacts patients from various backgrounds as clinicians think through ways to improve access to care and research efforts in MS.
Read More
Empowering Community Health Through Wellness and Faith
April 23rd 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. In the third episode, Camille Clarke-Smith, EdD, MS, CHES, CPT, discusses approaching community health holistically through spiritual and community engagement.
Listen
What We’re Reading: Abortion Privacy Rules; Alzheimer Drug Hurdles; Nursing Home Staffing Overhaul
April 23rd 2024New health privacy rules aim to protect patients and providers in an evolving abortion landscape; some physicians express concerns about efficacy, risks, and entrenched beliefs in treating Alzheimer disease; CMS addresses longstanding staffing deficits in nursing homes.
Read More
Overcoming Employment Barriers for Lasting Social Impact: Freedom House 2.0 and Pathways to Work
April 16th 2024To help celebrate and recognize National Minority Health Month, we are bringing you a special month-long podcast series with our Strategic Alliance Partner, UPMC Health Plan. Welcome to our second episode, in which we learn all about Freedom House 2.0 and the Pathways to Work program.
Listen
An Overview of Health Care and Pharmaceutical Trends, 2023-2024
April 19th 2024Douglas M. Long, BA, MBA, was featured as the keynote speaker on the closing day of The Academy of Managed Care Pharmacy 2024 annual meeting, with a session dedicated to surveying the health care and pharmaceutical trends of the last year.
Read More