Costly Specialty Drugs Put Heavy Fiscal Pressure on Pharmacies, Employers

| URAC Staff
Medicine Pills Scattered on Newly Designed U.S. One Hundred Dollar Bills

While studies showing employers are spending 40% of their drug costs on just 1% of all prescriptions, it’s never been more important for payers to partner with high-quality pharmacies and professionals at the top of their game.

In fact, it’s only going to become more important, says Heather Bonome, Director, Pharmacy at URAC, as many studies project that the 40% drug cost figure could climb to 60% over the next several years. When it comes to handling complex, expensive prescriptions such as biologic injectables, “there is so much more to being a pharmacist than counting pills” Bonome says.

Willis Tower Watson recently published a study that found that only ten drugs accounted for a full 20% of employers’ total pharmacy spend in 2018. In the report, Nadina Rosier, Pharm.D., and Head of Pharmacy practice at WTW added, “Pharmacy represents about 20% of employers’ overall health care spend and is expected to reach 25% by 2020.”

This dynamic puts a lot of pressure on pharmacies, Bonome says. They are being asked to dispense expensive and complex injectables and help ensure the prescription is the right fit for the individual patient. “Specialty pharmacists, trained properly, can provide critical clinical, financial and educational input to ensure these complex drugs are taken properly, avoiding potential harm to the patient and waste of valuable product,” Bonome says.

However, it’s not always easy for a payer or other customer to gauge the credentials of a pharmacy. Specialty pharmacies are regulated on a state-by-state basis and state regulations focus on general operational functions that are not specific to specialty medications. URAC’s Specialty Pharmacy Accreditation Program requires adherence to several key areas in addition to the requirements set out by pharmacy regulations.

Bonome cited Patient Management as a big differentiator in the URAC program. Because it is so important that these expensive and complex medications to be taken properly, it is imperative that the pharmacy conduct an initial clinical assessment to make sure the drug is right for the patient and periodically monitor the patient for adherence, side effects and efficacy. 

Patients also need to be trained on how to effectively administer their medications; they need to understand potential side effects, and they need to understand when and how best to keep the pharmacist informed of their progress. Otherwise, “patients sometimes stop taking the medication for the wrong reason” Bonome says. In that scenario, the patient is losing out on the benefits of the treatment, and the payer is incurring a large cost for on a product that’s not being used.

URAC standards also require a clinician be available 24/7. It doesn’t mean the pharmacy itself must be open, but the accredited operation must have a qualified clinician on call to answer patient or physician questions about these complex drugs.

Another key area covered by the URAC standards is cold-chain management. Because many of these expensive drugs are sensitive to temperature fluctuations, it’s imperative that they are shipped in secure containers that preserve steady temperature integrity. URAC’s standards address specific packaging and temperature management procedures and require a validated product-delivery program backed with rigorous testing.

It’s a higher bar to clear, designed to give a high level of confidence to patients, manufacturers, payers, employers and insurers, knowing they are working with an URAC-accredited specialty pharmacy, Bonome says. “Meeting the requirements of URAC accreditation demonstrates the specialty pharmacy is providing high-quality clinical care,” she adds.

For more information or to request a quote on our specialty pharmacy accreditation program, visit our Specialty Pharmacy webpage.

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