Smarter Decisions, Superior Outcomes

Managing Trends and Prescribing of Orphan Drugs

Posted by Kathleen Sabo on April 10, 2018 at 1:11 PM

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The development of orphan drugs, those used for the safe and effective treatment, diagnosis or prevention of genetic and rare diseases or disorders, is on the upswing.

In the past five years, 61 orphan drugs were approved. This is the largest for any five-year period since 1983, when Congress passed the Orphan Drug Act, a measure that gives financial incentives to encourage companies to develop drugs and biologics for rare diseases. The legislation includes tax credits to defray the costs of clinical trials and provides for fast-track FDA approval and market exclusivity. It's important because, before its passage, drug companies were weighing the financial viability of researching and developing these drugs. The Orphan Drug Act led to the development of hundreds of new drugs to treat a variety of conditions.

With orphan therapies on the rise, more people with rare diseases and genetic disorders have more treatment options designed to help them lead healthier, more productive lives.

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Topics: specialty drug pipeline,, rising drug costs,, patient outcomes,, drug costs,, population health, health plan management, pharmacy spend, orphan drugs, High Cost Medications

3 Common Myths about Prior Authorization Carve-Out

Posted by Kathleen Sabo on February 15, 2018 at 10:49 AM

There are three common myths circulating in the employer benefits marketplace regarding prior authorization (PA) services:

  1. All PA Programs are the same.
  2. My PBM won’t let me.
  3. It’s too confusing for members.

In this article, we’ll explore and dispel those myths and provide
a glance at the value of carving-out these programs from the pharma
cy benefit management contract. Successful PA programs, when managed effectively, are the gatekeeper to controlling soaring pharmacy expenditures while ensuring the right patient gets the right drug in the right dose at the right time.

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Topics: rising drug costs,, drug costs,, patient outcomes,, data accessibility, population health, health plan management, pharmacy spend, High Cost Medications, Prior Authorization Processing, Controlling Pharmacy Expenditures, Specialty Drug Cost Control, Prior Authorization, Coverage Determination Process, healthIT

Oncology Agents of 2016: A Clinical Review

Posted by Denika Hockenhull on December 5, 2016 at 1:34 PM

Oncology management has evolved due to approval of new oncologic agents and their expensive costs. Previously, limited medication availability left practitioners with minimal options for cancer treatment. Newer cancer agents are designed to improve a patient’s quality of life and hopefully, overall outcome. With the rapid development of new oncologic medications, the management process has posed a challenge to physicians and payers. Providing oncologic medications in the most cost-effective manner requires cost-management strategies to weigh the benefits and risks.

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Topics: drug costs,, pharmacy spend, Specialty Drug, High Cost Medications, Specialty Drug Cost Control, oncology, new cancer drugs, oncology medication, new oncology drugs, oncologic agents, FDA drug approvals

How Formularies Make an Impact

Posted by Denika Hockenhull on September 29, 2016 at 9:05 AM

Over the past few years, prescription drug costs have risen in a dramatic fashion. According to a federal report released this spring, prescription-drug spending rose 12.6% in 2014 and spending is expected to rise 7.3% a year through 2018. The increased cost is most closely associated with the influx of specialty drugs—high-cost prescription medications used to treat complex, chronic conditions. Rather than offset these prices, generic drugs costs are also experiencing an increase in price adding to the prescription drug cost burden. Drug utilization and the increasing cost of prescription drugs for members who require these medications as maintenance therapy is constantly in the forefront of discussion.

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Topics: drug costs,, formulary,, patient outcomes,

Balancing Effectiveness and Cost of Specialty Medications for Treating Complex Conditions

Posted by Denika Hockenhull on June 1, 2016 at 10:00 AM

Spending on specialty pharmaceuticals climbed 18 percent in 2015, compared to an increase of less than 1 percent for standard prescription medications. The burgeoning outlay comes as no surprise considering the hefty price tag of these new drugs, with some reaching upwards of $60,000 for a course of treatment.

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Topics: pharmacy spend, Specialty Drug Cost Control, Specialty Drug, patient outcomes,, biosimilars, interchangables,, drug costs,, rising drug costs,

Independent & Objective

Clinical expertise without the noise

Getting the facts matters. Following our corporate mission, we're committed to using this blog to enhance your knowledge of evolutionary events and discussions in the pharmacy services and technology arena. 

Here's what we're focused on right now:

  • Lowering ingredient cost
  • Enhancing the coverage determination process
  • Creating robust prior authorization criteria
  • Producing actionable drug trend analyses
  • Enhancing prescription drug monitoring 
  • Implementing interoperability efforts

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