Infusion site influences specialty drug spending, report shows

Changing the infusion site of specialty drugs can lower costs for patients with cancer, rheumatoid arthritis, multiple sclerosis, and other complex diseases, according to the 2013 Specialty Trend Management Insights Report, released by CVS Caremark.

The report reviewed strategies to control specialty drug spending, including the location of drug administration for infused medications, management techniques to control costs by moving drugs from the medical benefit to the pharmacy benefit, and use of services to improve healthcare outcomes while lowering patient and payor costs, a press statement said.

By 2020, drug spending for specialty medications is expected to reach $402 billion, quadruple the cost of these drugs today. “While many payors already have basic strategies in place to manage costs and ensure safe and effective use of specialty drugs, we have found that every plan has the opportunity to improve upon their management of this category,” said Jon Roberts, president of CVS Caremark’s pharmacy benefit management business.

Appropriate use of these drugs is a primary concern when managing patients with complex diseases that require specialty medications, said Alan Lotvin, MD, executive vice president of specialty pharmacy at CVS Caremark. “For example, the site of care where an infused drug is administered to the patient is one area that can significantly impact costs for the patient and payor without necessarily influencing the patient’s outcomes,” Lotvin said.

Infusions of specialty drugs, which are administered in the hospital setting at an increasing rate, cost dramatically more than in the physician’s office or in the home setting, according to the report. For example, infliximab (Remicade), a tumor necrosis factor blocker indicated for patients with Crohn’s Disease, ulcerative colitis, rheumatoid arthritis, and other complex diseases, costs approximately $5,400 for the drug and $425 on average for its administration in the hospital of a patient weighing 70 kg. When administered in the office, the drug and administration costs are approximately $2,800. At home, the combined cost of infliximab and its administration is about $3,400, according to CVS Caremark internal data in 2013.

Moving to pharmacy benefit

By moving certain specialty drugs from the medical benefit to the pharmacy benefit, payors can more easily track and manage costs of these expensive specialty drugs, the report noted.

“Consider moving drugs that are typically self-administered and those that are commonly infused in the home to the pharmacy benefit for better visibility and management,” according to the report. “Non-oncologic infused drugs-such as Xolair and Tysabri for multiple sclerosis, or Remicade for rheumatoid arthritis-can be made available under both the medication and pharmacy benefit.”

Specialty care teams are also a good investment to help patients by monitoring their outcomes and side effects, medication adherence, their refills, and by working through prior authorizations and benefit verification. Team nurses can help with non-pharmacy issues, coordinating with the patient’s healthcare provider and specialty care pharmacists, the report noted.