With specialty drugs expected to reach as much as half of total drug expenditures within the next few years, pharmacy benefit manager CVS Caremark has launched a new program designed to make the process of filling specialty medication prescriptions easier for plan members.
Specialty medications treat complex conditions such as hepatitis C, multiple sclerosis, psoriasis, cancer and arthritis and often require special handling, storage and administration. The Pharmacy Benefit Management Institute estimates specialty medications, which currently make up about 30% of total drug expenses, will increase to 50% or more of total drug expenditures by 2017 or 2018.
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Under the CVS Caremark program, Specialty Connect, patients have a new option to bring their specialty prescriptions to any CVS retail pharmacy location. The program also makes it easy for patients to get their specialty drugs, whether they choose between in-store pickup or receive their medications via mail order.
Once the prescription is received, it gets electronically routed to clinical experts who deal only with that particular condition. They are also experts in finding benefit support and financial support for these high cost drugs, explains Alan Lotvin, M.D., executive vice president of specialty pharmacy for CVS Caremark. The clinical expert reaches out to the patient to determine their needs and, at the end of the call, asks the patient whether they want to receive the drug at home or pick it up at a CVS retail location.
It really tries to create choice and flexibility for our patients, says Lotvin.
Half of specialty pharmacy patients in a pilot program in the Philadelphia area chose retail pickup of their specialty medications instead of traditional mail delivery. We think thats because its just more convenient than having to wait at home [for delivery] or worry about the drug, says Lotvin. Patients like to talk to a pharmacist and have that face-to-face.
Walgreens, meanwhile, uses a similar process for specialty drugs, says Joel Wright, divisional vice president, specialty solutions group at Walgreens. We help patients that come into our stores with specialty needs navigate to the appropriate level of clinical care, and then they can get their medications often through the store, he says. Probably the vast majority are actually able to be filled at our retail network.
In the past three years, the proportion of plan sponsors that apply common pharmacy benefit management tools prior authorization, step therapy, 30-day supply limits, for example has increased. According to PBMIs 2014 Specialty Drug Trend Report, for specialty drugs managed under the pharmacy benefit (as opposed to the medical benefit), prior authorization as increased to 90% in 2013, up from 82% in 2011, while the use of step therapy has jumped to 74% in 2013, up from 60% in 2011.
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