Seal and logotype of Brandeis University The Heller School logo

Recent Conferences

October 2, 2008

Specialty Pharmaceuticals: Policy Solutions for Encouraging Access and Affordability

On July 16, 2008 The Health Industry Forum held a conference on Specialty Pharmaceuticals that examined key market trends, specialty drug management strategies in Medicare and commercial insurers, and key social policy issues affecting access to and affordability of specialty products. This follow up meeting discussed potential policy solutions for the following issues identified during the July meeting:

1.    Independent and overlapping structure of medical and pharmacy benefits limits the potential for integrated medical management.

2.    Physician financial incentives often conflict with the most appropriate choice of specialty pharmaceuticals

3.    Uncertainty about the effectiveness of specialty pharmaceuticals - particularly for off-label uses - creates challenges for designing rational payment and coverage policies

4.    High coinsurance requirements for specialty pharmaceuticals (e.g., Tier 4) creates extreme financial burdens for beneficiaries who require expensive drug therapies

The objective of this meeting was to develop a refined set of policy options that provide an acceptable basis for continued discussion among a broad range of stakeholders.