Specialty pharmacy utilization continues to rise, Walgreens executive says

MIAMI — The utilization of specialty pharmacy is projected to steadily increase, Walgreens VP clinical affairs David Lorber told attendees Tuesday at the Pinsonault Associates Managed Markets Summit, which accentuates a need to augment patient compliance and help payers get a handle on what have become rapidly shifting economics.

“Specialty pharmacy is one of the most rapidly growing segments of total drug spending, which brings both concern as well as opportunity for enhanced efficiencies,” Lorber told attendees. “As more people rely on specialty pharmacy medications, the healthcare industry needs to place an emphasis on cost control, appropriateness of care, adherence and waste management.”

Lorber’s session took a hard look at the impact of specialty pharmacy on payers, including the role of adherence across a number of disciplines: cost management and containment, benefit and coverage decisions, formulary and medical policy, pipeline management, provider network and member satisfaction and disruption.

Because specialty medications include complex treatment regimens and medications that require special delivery, storage and handling, they typically cost about $2,000 for a 30-day supply — about 28 times the traditional retail prescription. Approximately 3% to 5% of the population takes a specialty medication, and that number is increasing.

Lorber discussed a case study that showed consistent patient adherence can result in savings. Walgreens multiple sclerosis patients adherent to medications, when compared to less adherent patients, resulted in savings of about $1.1 million for a large national insurance payer covering the 801 patients over a two-year period. The same case study also found that higher adherence reduced costs related to multiple sclerosis emergency room visits, inpatient stays and use of durable medical equipment.

“Improving the health and well-being of patients can be accomplished by providing convenient access to drugs and ensuring there is a consistent and coordinated care management programs,” Lorber said. “Patient counseling and education by trained pharmacists and nurses, like those at Walgreens and Take Care Health Systems, translates into fewer office visits as a result of improved adherence,” he said. “Proactive patient monitoring also drives early recognition of, and response to, adverse drug reactions and side effects, resulting in improved outcomes.”