Dr Steve Miller Discusses Specialty Pharmacy's Role in New Care Delivery Models

High costs associated with specialty pharmacy will necessitate the evolution of a new specialized model to help ensure that patients are receiving the financial assistance they need and adhering to their treatment, according to Steve Miller, MD, senior vice president and chief medical officer of Express Scripts.

High costs associated with specialty pharmacy will necessitate the evolution of a new specialized model to help ensure that patients are receiving the financial assistance they need and adhering to their treatment, according to Steve Miller, MD, senior vice president and chief medical officer of Express Scripts.

Transcript (slightly modified)

What is specialty pharmacy’s role in new care delivery models like accountable care organizations and patient-centered medical homes?

So when you’re talking about various patients’ very expensive therapies you’re actually going to need to deliver care in a much better way than we have historically. You don’t want to be wasting a single dollar so you don’t want a single patient not adhering. And so we’re really going to have to have a specialized model where we have specialized pharmacists and nurses and social workers dealing with each and every patient to make sure they actually get the patient the financial assistance they need, get the medical care they need, get the coordination of care they need. And so this is going to challenge the system where we’re going to have to evolve to a whole different model than what we have today.

In regards to indication-based pricing in oncology, what are the outcomes that are being considered? Is it overall survival alone or are surrogates, like duration of response rate, also being used?

With our indication-based pricing it’s starting in a small experiment because we have to actually get it right. That is, right now we need the integrity of the data so that we can report out to both the plan sponsors and the patients but also the pharmaceutical manufacturers about who’s being treated, what they’re being treated for. It’s a totally different way of processing claims. In the near future we’re actually going to be expanding it to where we’re looking at outcomes, and those outcomes are both financial outcomes but also clinical outcomes because we want to make sure that patients continue to get the very best care possible but also get savings where possible.