Affording the Future Mix of Medication Therapies
With some biologic medications costing $100,000 or more annually, to treat a patient with a serious chronic illness, how will payers and patients afford the accelerating shift towards biologics?
Dramatic increases ahead for spending on biologics.
Randy Vogenberg, RPh, PhD, noted consultant, author, and executive director of the Biologic Finance & Access Council Program at Philadelphia’s Thomas Jefferson University’s School of Population Health discusses how payers’ benefit design strategies may help more patients afford costly biologics and specialty medication therapies for chronic illnesses.
The overall mix of prescriptions is moving quickly away from chemical-based products towards biologics, gene-based therapies, that better manage disease, as well as offer potential cures.
Dr. Vogenberg discusses the shift and resulting impact on pharmacy benefit design as biologics and specialty medications dramatically increase their share of drug spending from 25% in 2010 to 50% in 2015. Current designs won’t address future medication needs. The traditional path favors reimbursing event-oriented, catastrophic coverage over chronic coverage.
But, innovations in benefit design and reimbursement have, and continue to evolve at large organizations, such as the Veterans Administration (VA), Centers for Medicare & Medicaid Services (CMS), and among self-insured employers. Lessons can also be learned from consumer-directed health plan designs that already exist, as well as from community-based initiatives to bring employees of small businesses, that employ more than half of the nation’s workforce, into plans offering improved medication benefits similar to those offered by government and large payers.
Dr. Randy Vogenberg advocates medication benefit design that recognizes the shift towards biologics.
Bio, Randy Vogenberg, RPh, PhD
Comparative Effectiveness Research
Engaging Physicians on Cost Savings Initiatives
Pharmaceuticals and the Challenges of Benefit Management
New Channels for Drug Distribution and Reimbursement
The Economics of the Specialty Pharmacy Benefit
Podcast (17 Min.) Affording the Future Mix of Medication Therapies
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