The Great Debate Part II

April 1, 2006



The American Journal of Managed

Care

Specialty pharmaceuticals elicit asignificant number of debates amongpayers regarding the best ways tomanage, monitor, and reimburse these therapies.One of these debates, entitled "TheGreat Debate: Consensus Guidelines orSpecialist Discretion for Managing SpecialtyPharmaceuticals?," appeared as a supplementto in August 2004, and was based on amoderated session held during that year'sannual spring meeting of the Academy ofManaged Care Pharmacy (AMCP) in SanFrancisco. This session focused on currentspecialty pharmacy policies from major managedcare organizations for biologics andinjectables and the wide spectrum of policiesused to manage these agents. In addition,speakers discussed the manner in whichtreatment guidelines and product labelingare used to shape policy determinations.

This summary is a continuation of theaforementioned debate, and it addresses thequestion that remains a focal point withinmost managed care pharmacy settings:Should managed care rely on cost sharing tomanage expensive biologics? Responses tothis question were addressed by Leslie Fish,RPh, PharmD, Diana I. Brixner, RPh, PhD,and Wayne M. Lednar, MD, PhD, in a moderatedsession held at the annual meetingof the AMCP in Nashville, Tennessee, onOctober 7, 2005. Attendees at this lively sessionalso participated by asking questions ofthe debaters and by responding to quick-pollingquestions posed by the moderator.