The Great Debate Part II

Diana I. Brixner, RPh, PhD; Leslie Fish, RPh, PharmD; and Wayne M. Lednar, MD, PhD

Specialty pharmaceuticals elicit a significant number of debates among payers regarding the best ways to manage, monitor, and reimburse these therapies. One of these debates, entitled "The Great Debate: Consensus Guidelines or Specialist Discretion for Managing Specialty Pharmaceuticals?," appeared as a supplement to The American Journal of Managed Care in August 2004, and was based on a moderated session held during that year's annual spring meeting of the Academy of Managed Care Pharmacy (AMCP) in San Francisco. This session focused on current specialty pharmacy policies from major managed care organizations for biologics and injectables and the wide spectrum of policies used to manage these agents. In addition, speakers discussed the manner in which treatment guidelines and product labeling are used to shape policy determinations.

This summary is a continuation of the aforementioned debate, and it addresses the question that remains a focal point within most managed care pharmacy settings: Should managed care rely on cost sharing to manage expensive biologics? Responses to this question were addressed by Leslie Fish, RPh, PharmD, Diana I. Brixner, RPh, PhD, and Wayne M. Lednar, MD, PhD, in a moderated session held at the annual meeting of the AMCP in Nashville, Tennessee, on October 7, 2005. Attendees at this lively session also participated by asking questions of the debaters and by responding to quick-polling questions posed by the moderator.

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