Specialty Pharma: A Prescription for Controlling Catastrophic Costs

PillWithMoney.jpgServing nearly 85% of the health plan market’s covered lives, Hayes makes it a priority to stay in touch with clients about what keeps them up at night. With a variety of plans all over the nation varying in size and product offerings, you can imagine we hear a lot of concerns. One of the recurring themes we hear is specialty pharmaceuticals. In fact, we have heard so much on the topic, it has been included as an accredited session at our Hayes Client Symposium this September.

Institutions are predominantly struggling to develop strategies and protocols to control the rising costs of specialty pharmaceuticals. In an effort to wrap their proverbial hands around this problem, there are certain potentially disruptive factors organizations need to analyze, monitor and ultimately, develop tactics for managing.

  • Biosimilars: Considerations should be made for where these are in the product pipeline and how they are being reviewed by the FDA.
  • Discounted Pricing: Specifically, organizations should gain an understanding of the 340B federal pricing program.
  • Oncology: Treatment strategies, medical homes, and bundled payments as it pertains to cancer are subjects that should be followed as well.
  • Mergers and Acquisitions: Changes in structural, organizational, and leadership activities amongst businesses is another topic to be monitored.
  • Ultra-High Cost Drugs: This refers to drugs for specific indications such as Sovaldi and Harvoni for Hepatitis C and PCSK9 inhibitors Praluent and Repatha for cholesterol management.
  • Personalized Medicine: Tracking the FDA’s involvement is important as genetic testing is an industry evolving rapidly and can have high associated costs that rapidly escalate combined with specialty pharmaceuticals.

During our symposium in September, we will explore this matter more thoroughly in a session entitled, “Specialty Drugs: Life-Saving Miracles or a Catastrophic Cost?” As one of our three accredited sessions during the event, we are excited to offer our clients some insight into the topic and hear from them about the impact this is having on their organization.

2016 Client Symposium

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