Addressing Every Aspect of Specialty Medications
Much in the same way our other Assist programs were designed to
help all those affected by the various situations that are addressed
within the program, the PAYERAssist
program provides innovative forward thinking and valuable services that payers have been searching for.
Our nearly two decades of specialized care makes us a necessary
resource for any Health Plan interested in solving the complications of Specialty Medications.
Whether you currently have a specialty drug program or are considering the benefits of one, you have probably asked:
- What makes a medication a 'Specialty' medication?
- What are the goals of initiating a specialty drug program?
- Which is more important price or profit?
- Which organization can provide the level of care and clinical expertise to meet our goals?
- Which organization can show a true value and document outcomes, provide clinical interventions as well as ensuring higher satisfaction among your groups?
- Is there an independent specialty pharmacy that can remain focused on the sole goal of better patient care, easier direct access for our organization as well as our members?
- Is a mandatory plan best? What about optional, or multiple provider?
- How will we impliment this program?
- How will we measure outcomes to determine the benefits of the program?
- Is there a specialty pharmacy that can show the value of successful outcomes as well as provide sometimes costly interventions as part of their standard protocol?
- If you currently have a program in place are you seeing the results you had expected? Are you seeing an increase in member and group satisfaction? Are you able to justify your program?
If you have a program in place or you are considering the benefits, a good place to start is by analyzing the pharmacy marketplace.
We can breakdown the common pharmacy situations this way:
Retail Pharmacy: A pharmacy which is also a retail store. Commonly does not stock high cost long-term treatments.
Most focus is on commonly prescribed medications. Pharmacist access is limited after-hours access uncommon.
Specialty Mail Order: A facility that commonly dispenses 90 days of medication at a time.
Many specialty mail order facilities now are operating retail pharmacies as well.
Additionally, the majority of specialty mail-order facilities are owned partly
or in whole by Prescription Benefit Management companies.
Specialty Pharmacy: Pharmacy that is completly focused on the needs of complex treatments
including infusion patients. An advocate for the best in patient care for
long-term treatments for the chronically ill and demonstrates the difference in
better patient care by measuring outcomes.
So what do these differences mean to you?
| Specialty Drug Channel | Specialty Mail Order |
Specialty Pharmacy |
|---|
| Inventory Accessibility |  | |
24-hour access to
Doctors of Pharmacy | | |
| Compliance Monitoring | | |
| Ongoing Program adjustments | | |
| Outcomes Tracking | | |
| Outcomes Reporting | | |
| Detailed Therapy | | |
| Management Programs | | |
| Utilization and Formulary Support | | |
| Nurse Teaching for Self-Injectables | | |
| Customizable Programs | | |
| Higher Compliance than retail pharmacy
| | |
The PAYERAssist
program from BioPlus also helps by differentiating between PRICE and PROFIT.
As a healthplan how do you make this determination?
DID YOU KNOW?!
Noncompliance costs health care payers $100 Billion dollars annually!
Noncompliance leads to $1.5 Billion dollars in lost revenue. This revenue loss is felt by the employer groups that you, the payer, provide for.
Noncompliance accounts for 10% of hospital admissions at an annual rate of $15.2 Billion dollars.
This is a profit loss to managed care organizations or self funded plans which pay that bill.
Additionally, better compliance can help health plans make clearer decisions regarding formulary choices.
The Specialty Drug spend is estimated to be increasing 26% per year or an estimated $75 Billion dollars in 2008.
If you currently have some sort of specialty medication plan, why wait to review your options?
You may realize that you are actually using a specialty mail order organization.
For plans without a specific program, let us assist you in reviewing the information we briefly touched on in a more in depth process …
The program name says it all … PAYERAssist,
let us assist you in every aspect of your specialty drug program.
For more information please
contact our PAYERAssist specialists.