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PLANO, Texas, March 06, 2019 (GLOBE NEWSWIRE) -- The Pharmacy Benefit Management Institute’s (PBMI’s) 2019 Trends in Specialty Drug Benefits report shows that medical benefit reporting still has a 50% gap with only half of respondents stating that their pharmacy benefit manager (PBM) or health plan tracks specialty and nonspecialty drug spend for drugs under the medical benefit. Having visibility into the medical side helps to provide a comprehensive view of the patient. Timely, accurate, and actionable reporting is key to measuring how a plan is doing in terms of specialty drug benefit management. PBMI released the report, sponsored by Walgreens and AllianceRx Walgreens Prime, yesterday at its 2019 National Conference in Palm Springs, California.
“Specialty drug spend is now 50% of total healthcare spend and this is expected to trend up in the years ahead,” says Jane Lutz, Executive Director, PBMI. “With new specialty drugs entering the market, employers will need more in-depth reporting to help make informed decisions about their benefit plans.”
“This report is an important tool to monitor trends and identify barriers to reducing costs. One strategy that has become crucial to addressing these barriers is working with partners to develop new solutions for patients, providers and plan sponsors,” said Rick Gates, Senior Vice President, Pharmacy and Healthcare, Walgreen Co. “Walgreens’ collaboration with Prime Therapeutics and AllianceRx Walgreens Prime enables us to bring together pharmacy benefit management, health plans and the pharmacy to deliver innovative solutions that increase engagement and adherence, while improving outcomes and lowering costs.”
Joel Wright, chief executive officer of AllianceRx Walgreens Prime says employers and health plans demand more sophisticated pricing strategies to manage costs. “Our parent companies – Prime Therapeutics and Walgreens – have specific strategies to manage both the medical and pharmacy drug spend which is one of the biggest benefits that AllianceRx Walgreens Prime brings to helping manage the patient journey. Using data-driven decisions helps drive cost management solutions that can improve access to appropriate medications and increase savings for patients and their families so they can live their best lives,” says Wright.
According to the report, 67% of respondents can track total healthcare outcomes and 63% can track adherence and persistency. However, only 27% can track clinical efficacy and just 9% are able to track the impact of medications on employee productivity. Among desired outcome reporting were clinical alternatives and cost impact, drug switch rates/change in therapy, long-term cost avoidance by drug, and outcomes related to specific therapies.
Employers have several goals for their specialty drug benefits. In addition to managing the costs of specialty, the research shows that appropriate use and utilization management (22%), adherence (11%), access to medications (7%), and clinical outcomes (6%) are other primary goals for employers. To manage their benefits, more employers are implementing a separate cost sharing tier for specialty drugs (up to 59% from 56% in 2017), but formulary exclusions have remained stable (60%) with interest from some to implement in the future (33%).
The research also includes a section on calcitonin-gene-related peptides (CGRPs), the first biologic medications specifically developed to treat migraines. These medications were recently approved by the FDA last year. Most respondents reported that their plan covers traditional preventive and acute treatment for migraines, however only 22% of employers cover CGRPs because they are either unaware of these medications or need more outcomes.
This is just a sampling of the results from this report. To download a copy, click here. PBMI is hosting a live webinar on March 12th at 1:30 pm eastern to present findings from the report. Click here to register for the webinar.
The Pharmacy Benefit Management Institute (PBMI) is the nation’s leading provider of research and education that informs, advises, and influences the industry on topics related to drug cost management. PBMI offers research, continuing education, and web resources to help all critical stakeholders work better together to optimize the overall value of drug benefit programs. To learn more, visit www.pbmi.com.