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Specialty drug strategy delivers savings and support
As spending for specialty drugs increases, we make use of several strategies to manage costs. Because we manage both medical and pharmacy for you, we can manage your employees’ treatment more holistically for this class of drugs.
Our strategies for managing specialty drugs help:
• Drive superior clinical outcomes
• Lower total cost of care
• Identify and manage future costs based on drugs in the pipeline • Simplify the overall member experience
Specialty pharmacy program
Our specialty pharmacy program provides convenient delivery options and support for members with complex and high-cost conditions, including cancer, hemophilia, hepatitis C, rheumatoid arthritis, multiple sclerosis, and cystic fibrosis.
Starting with their first fill, we offer these members counseling from experienced pharmacists and nurses by phone or video chat, as well as online videos, support materials, and resources.
Most Cost-Effective Setting
Our Most Cost-Effective Setting program helps members with rare or complex high-cost conditions receive the appropriate medication in their home, provider’s office, or infusion center, where it costs three to four times less than if they received it in a hospital. Since the program’s inception, we’ve saved more than $105 million and continue to add new drugs every year.
Biosimilars can help reduce overall costs
We are always looking for innovative ways to make specialty drugs more affordable without restricting members’ access. As part of these efforts, we have been closely following the recent launch and growth of biosimilars in the U.S. drug market. Biosimilars are less expensive FDA-approved versions of biologic drugs, commonly used for vaccines, allergenics, and cancer treatments.
Because of the growth and savings potential of biosimilars, we are proactively monitoring the drug pipeline and applying utilization management strategies to increase member and provider use of this class of drugs, while decreasing treatment costs.
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PROBLEM
Specialty drugs1
$400 billion estimated national spend
9% + national health care spend
1 Nationally by 2020
2 Based on internal data
Most Cost Effective Setting program2
Over 70 drugs currently covered
$105+ million in savings
ACTION
RESOLUTION
Strategies
Clinically appropriate drugs for members
Safe, cost-effective treatment setting
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