July 16, 2008

Managing Specialty Pharmaceuticals: Balancing Access and Affordability

The growing availability of specialty pharmaceuticals - typically biological therapies which cost tens of thousands of dollars for a course of treatment - represents an emerging challenge for U.S. social policy. Specialty pharmaceutical costs are rising at double digit rates that will likely accelerate as new products emerge from clinical development. While these products have sometimes demonstrated miraculous results in clinical trials, it is often difficult to identify which patients will benefit from specific treatments. To limit the economic burden, payers are trying to curb off-label and low-value uses for these products. They are also concerned about the existing distribution system in which physicians can earn large profits by purchasing and re-selling the drugs. Some benefit plans have moved certain specialty drugs into a “Tier 4” with significantly higher coinsurance. As a result, patients may be responsible for significant costs and face agonizing decisions over whether to accept potentially life saving treatments. 

This Health Industry Forum focused on strategies for balancing the access and affordability in the US market for specialty pharmaceuticals.  It included an analysis of the specialty pharmaceutical market, examination of specific health plan strategies covering clinical management, reimbursement, specialty pharmacy contracting, and benefit design, an assessment of key Medicare issues, and a discussion of future public policy issues.

• Agenda
• Participants
• Policy Brief
• Conference Report