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Speciality Pharmacy: Neglect is not an option for employers

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Tim Thomas
Tim Thomas

Tim Thomas, founder and managing director of Crystal Clear Rx, discusses how employers can rethink their role in Specialty Pharmacy. He shares advice on mitigating Speciality Rx by looking for proper dosing, appropriate use and evaluating cost plus pricing in AWP discounts.

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Specialty Pharmacy: Neglect is not an option for employers Tim Thomas, R.Ph President, Crystal Clear Rx
Specialty Pharmacy $ on Specialty Pharmacy % of Pharmacy Spend on Specialty CVS Health Dec 2014 Billions
Predictions "We don't like their sound, and guitar music is on the way out." Decca Recording Company on declining to sign the Beatles, 1962
"I think there is a world market for maybe five computers." Thomas Watson, chairman of IBM, 1943 Predictions
Specialty Pharmacy will be 50 % of the pharmacy spend by 2018 ????? Predictions
We all know Specialty Pharmacy is the coming Tsunami 50 % of your cost by 2018? MAYBE
We all know Specialty Pharmacy is the coming Tsunami 50 % of your cost by 2018? MAYBE More 100,000 plus therapies DEFINITELY
We all know Specialty Pharmacy is the coming Tsunami 50 % of your cost by 2018? MAYBE More 100,000 plus therapies? DEFINITELY Is there anything that can be done? ABSOLUTELY
Specialty Pharmacy versus Traditional Lets assume that Specialty pharmacy will be a large portion of the spend (40 to 50 %) 40 to 50 % of the drug spend on less than 1 % of the population compared to 50 to 60 % of the drug spend on around 30 to 40 % of the population Should it be managed the same way that traditional pharmacy has been managed?
Specialty Pharmacy differences Patient management and review is different than traditional More side effect potential Obviously more costly therapies Rebates are much bigger but caution is warranted
Specialty costs can be mitigated Integrating medical and pharmacy claims for analysis can show opportunity for savings
Specialty costs can be mitigated Site of care/appropriate use Proper dosing Evaluate cost plus pricing compared to any AWP discount
Pricing example: Harvoni AWP...................................$37,800 AWP14%..............................$32,508 AWP16%..............................$31,752 Cost Plus model$30,630 Savings between $1,122 and $1,878 each month by using cost plus model
PBM or not to PBM Specialty PBMs can handle Specialty pharmacy but should they? An alternative is to carve out to another vendor that specializes in Specialty Pharmacy Another thought is to engage a company for prior authorizations and clinical review
In closing. Specialty Pharmacy may not go to 50 % of the cost, but it will still be a major factor in pharmacy cost for the foreseeable future. It needs to be managed differently than traditional pharmacy

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Speciality Pharmacy: Neglect is not an option for employers

  • 1. Specialty Pharmacy: Neglect is not an option for employers Tim Thomas, R.Ph President, Crystal Clear Rx
  • 2. Specialty Pharmacy $ on Specialty Pharmacy % of Pharmacy Spend on Specialty CVS Health Dec 2014 Billions
  • 3. Predictions "We don't like their sound, and guitar music is on the way out." Decca Recording Company on declining to sign the Beatles, 1962
  • 4. "I think there is a world market for maybe five computers." Thomas Watson, chairman of IBM, 1943 Predictions
  • 5. Specialty Pharmacy will be 50 % of the pharmacy spend by 2018 ????? Predictions
  • 6. We all know Specialty Pharmacy is the coming Tsunami 50 % of your cost by 2018? MAYBE
  • 7. We all know Specialty Pharmacy is the coming Tsunami 50 % of your cost by 2018? MAYBE More 100,000 plus therapies DEFINITELY
  • 8. We all know Specialty Pharmacy is the coming Tsunami 50 % of your cost by 2018? MAYBE More 100,000 plus therapies? DEFINITELY Is there anything that can be done? ABSOLUTELY
  • 9. Specialty Pharmacy versus Traditional Lets assume that Specialty pharmacy will be a large portion of the spend (40 to 50 %) 40 to 50 % of the drug spend on less than 1 % of the population compared to 50 to 60 % of the drug spend on around 30 to 40 % of the population Should it be managed the same way that traditional pharmacy has been managed?
  • 10. Specialty Pharmacy differences Patient management and review is different than traditional More side effect potential Obviously more costly therapies Rebates are much bigger but caution is warranted
  • 11. Specialty costs can be mitigated Integrating medical and pharmacy claims for analysis can show opportunity for savings
  • 12. Specialty costs can be mitigated Site of care/appropriate use Proper dosing Evaluate cost plus pricing compared to any AWP discount
  • 14. PBM or not to PBM Specialty PBMs can handle Specialty pharmacy but should they? An alternative is to carve out to another vendor that specializes in Specialty Pharmacy Another thought is to engage a company for prior authorizations and clinical review
  • 15. In closing. Specialty Pharmacy may not go to 50 % of the cost, but it will still be a major factor in pharmacy cost for the foreseeable future. It needs to be managed differently than traditional pharmacy