Dr Lametra Scott Discusses Cost, Formulary Guidance in Managing Sickle Cell Disease

October 23, 2020

While sickle cell disease is not prevalent in the general population, the significant cost associated with the condition warrants action from payers and formulary decision makers to improve patient access and align cost with their budgetary goals.

While sickle cell disease is not prevalent in the general population, the significant cost associated with the condition warrants action from payers and formulary decision makers to improve patient access and align cost with their budgetary goals, said Lametra Scott, PharmD, community advocate and founder of Breaking The SSickle Cell Cycle Foundation, Inc.

Transcript

AJMC®: At this year’s AMCP Nexus 2020 virtual meeting, a panel on sickle cell disease (SCD) will discuss access and efficacy of novel therapies. Can you talk about what these therapies mean for patients?

Dr Scott: The new therapies that have come about in the last year or so, including back in 2017, these new therapies actually provide new treatment options for patients who may have failed current therapies and didn't have any other options to choose from and they had to rely mostly on blood transfusions, or for those patients for which they tried the new therapies and they just didn't work. Outside of that, there were no other options. So, with these new players that come to the table, we've actually increased access to treatment options, and also provided treatment in areas where there once probably was not an option.

AJMC®: What are some of the issues patients are having accessing these therapies?

Dr Scott: One of the biggest issues that I have come across in speaking with patients is that while these products are available on the market, they're not available to them. What that means is they may not be available via their formulary options for their insurance carriers, and even if they are available, the cost of them is prohibitive for some being able to access. So, if they're not aware or not tied into patient access programs, they still are not able to reap the benefits that these medications provide.

I would say my discussion at AMCP Nexus is definitely something that all payers, no matter what your role is in the insurance company, whether you're the claims payer, whether you're the formulary decision maker–whatever your role is, this is definitely a discussion that you will want to take part in because oftentimes SCD patients are overlooked or the disease state of treating SCD because it doesn't affect a large number of people.

It’s not really something that a lot of people spend a lot of time on, but at the same time, patients who have SCD, to treat a SCD patient costs a significant amount of money. So, therefore, this is something that while it may not affect a lot of people, you definitely want to pay attention to make sure that you're treating these patients appropriately because their disease phase can actually push your budget. Pushing your budget to the point of: okay, what are we going to do to help control the costs in this particular area?

So, I will share information on helping you determine when you go to add medications to your formulary, what are some things that you need to look for when you treat SCD patients in general, what are the additional things that you need to look for in addition to SCD–the conditions that affect SCD that you need to make sure that you're treating appropriately or making sure that you have equitable access to. We also will discuss, again, those budgetary constraints associated with SCD. We’ll talk about how you can incorporate these medications and at the same time, make sure you're using funds judiciously. So, those are definitely some things that would help you in going forward and taking care of sickle cell patients.