Top Specialty Drug Management Goals for Employers: Emphasis on Patient-Centered Approach

In today's rapidly evolving healthcare landscape, employers face a myriad of challenges in managing specialty drugs. These treatments, often vital for addressing complex and chronic conditions, come with hefty price tags and unique care requirements. As such, it's imperative for employers to not only provide access to these essential therapies but also to ensure that they are managed effectively to optimize patient outcomes while controlling spend.

Employers have a vested interest in the health and well-being of their employees. A healthy workforce is not only more productive but also contributes to a positive company culture and overall success. Specialty drugs play a crucial role in maintaining the health and productivity of employees, particularly those with chronic or severe medical conditions. Ensuring access to these treatments and managing them appropriately is not just a matter of healthcare provision but also a strategic business imperative.

Here we discuss some top goals employers are focusing on as they manage trends specialty drug utilization and spend. The goals outlined for specialty drug management are not just about cost containment; they are fundamentally about prioritizing patient-centered care. Employers recognize that the health and satisfaction of their employees are paramount. By focusing on driving measurable health outcomes while reducing unnecessary spending, employers can demonstrate their commitment to employee well-being and foster a culture of care and support within the organization.

Manage Overall Specialty Trend/Specialty Drug Cost

Why Employers Care: For most employers, specialty drugs account for between 2% to 4% of the total drug utilization while accounting for 50% to 56% of their total drug spend. Managing specialty drug spend is one employers simply can’t ignore. Controlling the overall trend of specialty drug spend is crucial for employers to maintain financial sustainability while providing quality healthcare benefits to employees.

Impact on Patient Care and Cost: Implementing strategies to manage specialty drug costs ensures that employers can allocate resources effectively, balancing the needs of their workforce with budgetary constraints. This, in turn, supports better patient care by preserving access to essential treatments while mitigating the financial burden on both employees and the organization.

Managing Total Cost of Care in Specialty Drug Management

Specialty drug management should go beyond merely focusing on the drugs themselves; it should encompass all aspects of care related to a specific condition.

Why Employers Care: Managing the total cost of care involves considering all healthcare expenses incurred by employees for a specific condition, not just the cost of specialty drugs.

Impact on Patient Care and Cost: By optimizing healthcare utilization and spending across all facets of care, employers can ensure that resources are allocated efficiently to support better patient outcomes. This approach may involve high touch disease state management, promoting preventive care, coordinating care between providers, and implementing wellness initiatives, ultimately leading to improved management resulting in measurable health outcomes and reduced overall healthcare costs for both employers and employees.

Reduce Inappropriate Utilization

Why Employers Care & Impact on Patient Care: Employers are deeply concerned about inappropriate utilization of specialty drugs due to its significant impact on healthcare costs and patient care. Depending on the employer, an average of 30-50%, and sometimes even higher, of their specialty spending is wasteful. Addressing this issue is crucial as it allows employers to mitigate unnecessary healthcare costs associated with inappropriate use, ultimately impacting their bottom line. By identifying and rectifying instances of unoptimized utilization, employers can streamline healthcare spending, ensuring efficient allocation of resources. Moreover, ensuring that patients receive the correct drug, at the appropriate dose, and timing, enhances the quality of care provided to employees.

Collaborating with appropriate vendors on specialty drug management strategies is essential, necessitating a proactive approach rather than solely relying on retrospective strategies. Employing both Front-End Prescription Drug Management: Prior to Initiating Therapy and Back-End Prescription Drug Management: During Duration of Therapy is imperative. Front-End prescription management strategies include formulary strategies and utilization management strategies like prior authorization, step therapy, and quantity limit initiatives. Coupled with a Back-End prescription drug utilization management strategy that involves proactive and ongoing management, leveraging various forms of data, including lab data for drugs requiring clinical laboratory monitoring, helps continuously monitor unoptimized utilization. This approach ensures that specialty drug utilization aligns with evidence-based guidelines.

Addressing unoptimized utilization of specialty drugs not only benefits employers financially but also enhances patient care and reduces avoidable spending

Reduce Patient Out-of-Pocket Costs

Why Employers Care: Employers are concerned about the impact of high out-of-pocket costs on employees' access to specialty drugs. These costs can create financial barriers, potentially leading to treatment non-adherence and poorer health outcomes. When employees struggle to afford their medications, they may skip doses or forgo treatment altogether, jeopardizing their health and well-being.

Impact on Patient Care & Cost:

By taking steps to reduce patient out-of-pocket costs, such as implementing benefit design changes, offering copay assistance programs, or exploring other initiatives, employers can improve medication adherence and treatment compliance among their workforce. When employees can afford their medications, they are more likely to adhere to their prescribed treatment regimens, leading to better health outcomes. Additionally, addressing out-of-pocket costs helps mitigate the long-term costs associated with untreated or poorly managed conditions. By investing in initiatives that lower patient financial burdens, employers can ultimately improve the health and productivity of their employees while reducing overall healthcare expenses.

 Improve Patient Satisfaction

Why Employers Care: Patient satisfaction is closely linked to overall healthcare quality and employee morale. In the realm of specialty drugs, where treatment regimens can be complex and require careful management, patient satisfaction becomes even more critical. Navigating the landscape of specialty drugs, especially when utilization management strategies are involved, can be overwhelming for patients. Therefore, it is important that, when possible, employers recognize the importance of ensuring that their employees have access to assistance and support to navigate this intricate process.

Impact on Patient Care and Cost: By focusing on improving patient satisfaction, employers can foster a positive healthcare experience for employees, leading to increased engagement, better treatment adherence, and ultimately, improved health outcomes. This not only enhances the overall well-being of employees but also contributes to higher productivity and reduced healthcare costs associated with avoidable complications or hospital readmissions.

Furthermore, providing assistance services like patient navigation for specialty drug-related matters can significantly enhance patient satisfaction. Patient navigation services help patients understand their treatment options, navigate insurance coverage, and adhere to prescribed medication regimens. By offering these support services, employers demonstrate their commitment to ensuring that employees receive comprehensive care and support throughout their treatment journey, ultimately leading to higher satisfaction levels and better health outcomes.

 Improve Specialty Drug Adherence

Why Employers Care: Adherence with specialty drug regimens is essential for achieving optimal treatment outcomes and controlling healthcare costs. As mentioned in the above section, ensuring patient access to specialty drugs is vital, but equally important is their continued adherence to these therapies. Employers recognize that without proper adherence, the benefits of specialty drugs may not be fully realized, leading to suboptimal health outcomes and potentially higher healthcare costs in the long term.

Impact on Patient Care and Cost: By implementing adherence support programs, providing patient education, and offering incentives for medication adherence, employers can help ensure that employees receive the full benefits of specialty drug therapy. Additionally, addressing patient cost-sharing is key as part of adherence strategies, as members may abandon therapy if their out-of-pocket costs are too high. Improving specialty drug adherence not only leads to better disease management and fewer hospitalizations but also results in reduced overall healthcare costs over time. Through proactive measures to support adherence, employers can promote better health outcomes for their employees while effectively managing healthcare expenditures.

Increase Transparency

Why Employers Care: As specialty drugs continue to take a larger share of healthcare spend for employers, transparency has become a critical focus. Transparency is crucial in specialty drug management contracts with vendors for employers. This is because the lack of transparency in specialty contracts can have significant financial implications. Employers engaging with PBMs and Health Plans for specialty drug management must prioritize transparency in their contracts. It ensures that employers have a clear understanding of pricing, coverage policies, formulary management, rebate management, and any potential conflicts of interest. Transparency allows employers to hold their vendors accountable and verify any inappropriate practices, preventing unnecessary spending.

Impact on Patient Care and Cost: By promoting transparency in specialty drug pricing, coverage policies, and treatment options, employers can empower employees to make cost-effective healthcare decisions. This not only fosters a sense of trust and partnership between employers and employees but also leads to better health outcomes and more efficient use of healthcare resources. Additionally, transparency enables employers to identify and address inefficiencies or inappropriate practices, ultimately reducing unnecessary spending and ensuring that resources are allocated effectively to support patient care.

Manage Cost Parity & Site of Care Across Pharmacy and Medical Benefit

Why Employers Care: A recent report by Axum revealed that nearly 40% of specialty drugs approved from 2021 to 2023 fall under the medical benefit category, highlighting the crucial need for specialty drug management within medical benefits. While pharmacy benefit managers (PBMs) employ various management strategies for specialty drugs, it's imperative for employers to ensure similar strategies are deployed under the medical benefit. Additionally, effective management of the site of care ensures that employees receive treatments in settings that are not only appropriate but also cost-effective. Moreover, coordinating care across pharmacy and medical benefits guarantees comprehensive cost parity and facilitates seamless data access between the two benefits.

Impact on Patient and Cost: Through strategic coordination, employers can guide employees to the most suitable and economical care settings. Integration of healthcare data across both pharmacy and medical benefits facilitates the identification of optimization opportunities, enhancing management and resulting in improved outcomes and cost savings. Achieving cost parity ensures fair access to specialty drugs while simultaneously reducing administrative complexities. Ultimately, these measures lead to enhanced patient care and decreased overall costs.

Importance of Patient-Centered Specialty Drug Management

As employers collaborate with their Pharmacy Benefit Managers (PBMs), health plans, and other vendors on specialty drug management strategies, the question of patient-centeredness should be a priority. While cost-saving measures are essential, it's crucial to prioritize the patient in every decision made. Over the years, we've witnessed numerous specialty drug management strategies that initially appear promising due to potential cost savings. However, upon closer examination, these strategies may lead to adverse outcomes for employees and employers in the long run, both clinically and financially.

For instance, strategies aimed solely at cost reduction may inadvertently result in members facing high out-of-pocket costs or abandoning therapy altogether. These outcomes can contribute to increased healthcare utilization elsewhere, offsetting any initial cost savings achieved. Therefore, every decision made by employers must consider both the short and long-term implications for members.

At the core of specialty drug management is the imperative to ensure that patients have access to life-saving therapies when they need them, and can take them optimally without unnecessary burdens to access. While cost-saving measures are crucial, they should never detract from the primary objective of improving patient outcomes and enhancing the quality of care provided.

A crucial aspect of maintaining a patient-centered approach while focusing on cost reduction is the implementation of a comprehensive specialty drug management program. Such a program should address all aspects of specialty drug management needs across both pharmacy and medical benefits. It's essential for specialty drug management solutions to incorporate a robust clinical program, effective financial management strategies, and drug utilization optimization and waste elimination initiatives, all while ensuring patient support and satisfaction. By adopting a patient-centered program that also prioritizes cost reduction, employers can effectively navigate the complex landscape of specialty drug management while ensuring that patients receive the best possible care without compromising financial sustainability. This holistic approach not only leads to improved patient outcomes but can also contributes to long-term cost savings and overall satisfaction among all stakeholders involved.

Partnering with Axum Rx for Patient-Centered Specialty Drug Management

Is managing specialty drugs in a patient-centered manner is crucial for you? Founded by pharmacists, Axum Rx offers a transparent approach to specialty drug management across pharmacy and medical benefits. By collaborating with Axum Rx, employers can optimize their specialty drug management programs, drive measurable patient health outcomes, and reduce costs. Learn more about how Axum Rx can help you achieve your specialty drug management goals with a patient-centered approach: Axum Rx Solutions.