A panel of multidisciplinary experts from academia, clinical practice,
policymaking, patient advocacy, the pharmaceutical industry and pharmacy
benefit management convened today to discuss and debate the growth of
specialty pharmaceuticals and their clinical, economic and industry
impact on the U.S. health care system.
Dirk McMahon, CEO of OptumRx, and Lauren Barnes, Senior Vice President, Avalere Health, joined other health care, biotech and health policy experts in New York to discuss specialty pharmaceuticals at a roundtable discussion, "Perspectives on Specialty Pharmaceuticals: Managing Innovation and Cost," hosted by OptumRx and the UnitedHealth Center for Health Reform & Modernization (Photo: Bennett Raglin).
The event, “Perspectives on Specialty Pharmaceuticals: Managing
Innovation and Cost,” coincided with the publication of an issue brief
on specialty pharmacy by the UnitedHealth Center for Health Reform &
Modernization called The
Growth of Specialty Pharmacy: Current Trends and Future Opportunities.
The issue brief offers new data and insights from UnitedHealth Group on
the challenges of managing specialty pharmacy as well as practical
solutions in five areas.
Panelists who participated in the roundtable discussion included: Lauren
Barnes, senior vice president, Avalere Health; Bill Crown, Ph.D., chief
scientific officer, Optum Labs; Dirk McMahon, CEO, OptumRx; Lee N.
Newcomer, M.D., senior vice president of Oncology, UnitedHealthcare;
Eleanor Perfetto, Ph.D., professor of Pharmaceutical Health Services
Research, University of Maryland School of Pharmacy; Brian Rosen, senior
vice president, Public Policy, The Leukemia & Lymphoma Society; and
Laurel Todd, managing director, Reimbursement & Health Policy,
Biotechnology Industry Organization (BIO).
Specialty pharmaceuticals are a relatively new class of drugs that have
important treatment implications for people with chronic and progressive
diseases such as multiple sclerosis, hepatitis C, hemophilia, rheumatoid
arthritis and certain types of cancer. In 2012, specialty
pharmaceuticals accounted for 65 percent of spending on new drugs (those
introduced in the past two years), according to IMS Health. Specialty
pharmaceuticals represent the fastest growing prescription medications
market in terms of growth and cost, with spending increasing at about 20
percent a year — much higher than for any other health care benefit.
During the roundtable, panelists discussed future growth trends,
challenges in managing costs, information and data needs, clinical
models to better serve patients and how to ensure that patients
understand and use these drugs correctly to achieve better health
outcomes, and which best practices can be leveraged for cost savings in
the health care system.
Consensus emerged from the diverse group of panelists around the need to
better define the value to all health system participants of specialty
pharmaceuticals and the complexity in reaching a definition; the growing
importance of collaboration and partnerships to drive innovation and
modernize the health care delivery system; the health and cost benefits
of more fully integrating medical and pharmacy data; and the critical
need to better engage and educate patients throughout the research,
development and care decision-making process.
“The growth of specialty drugs has the potential to significantly
improve the health outcomes, productivity and lives of patients with
chronic and progressive diseases,” said Dirk McMahon of OptumRx, a
pharmacy benefits management company. “In order to best manage the
development, usage, effectiveness and cost of specialty drugs and their
broad impact on the health system, it is critical for PBMs, payers,
manufacturers and policymakers to work together to address the needs of
all stakeholders. Beyond industry collaboration, it is important to
manage specialty drugs in the context of overall health outcomes and
costs.”
Millions of working-age Americans live with diabetes, asthma, hepatitis
C, rheumatoid arthritis, cancer, HIV and other serious diseases. Many of
these individuals are able to continue working and have improved quality
of life due, in large part, to the introduction of highly effective
specialty pharmaceuticals. However, the high cost and complexity of
these treatments are having a significant cost and management impact on
patients and payers.
“Innovative specialty medications, such as targeted therapies and
immunotherapies, are leading to breathtaking progress in survival rates
for many blood cancer patients,” said Brian Rosen of The Leukemia &
Lymphoma Society (LLS). “The challenge – one that LLS is committed to –
is advocating for enlightened public policies that provide sustainable
patient access to lifesaving specialty medications while encouraging
advancement in medical innovation.”
“While there are accepted guidelines for conditions such as rheumatoid
arthritis and multiple sclerosis, care providers have much less evidence
to guide them in selecting medications, treatment duration and dosage
for patients with other diseases. The rapid emergence of new treatments
further compounds this challenge,” said Lee Newcomer of
UnitedHealthcare. “As a result, patients may continue to take complex
medications that are minimally or no longer effective, incurring the
costs of these drugs as well as enduring their side effects.”
All panelists agreed that there is a pressing need for more
evidence-based guidelines for usage of specialty drugs across a broad
range of diseases. With improved information, stakeholders would be
better positioned to guide treatment decisions or develop outcomes-based
approaches to contracting. Advances in comparative effectiveness
research also would help to inform those discussions.
The roundtable was sponsored by OptumRx and the UnitedHealth Center for
Health Reform & Modernization.
About OptumRx
OptumRx is an innovative pharmacy benefit
management business managing the prescription drug benefits of
commercial, Medicare, Medicaid and other governmental health plans, as
well as those of employers and unions through a national network of
66,000 community pharmacies and state-of-the-art mail service pharmacies
in California and Kansas, both of which have earned the prestigious
Verified Internet Pharmacy Practice Sites™ (VIPPS) accreditation by the
National Association of Boards of Pharmacy. OptumRx is part of Optum, a
leading information and technology-enabled health services business
dedicated to making the health system work better for everyone. Visit www.optum.com
for more information.
About UnitedHealth Center for Health Reform & Modernization
The
UnitedHealth Center for Health Reform & Modernization assesses and
develops innovative policies and practical solutions for the health care
challenges facing the nation. Drawing on UnitedHealth Group’s internal
expertise and extensive external partnerships, its work falls into six
priority areas:
-
Developing innovative approaches to universal coverage and health
benefits, grounded in evidence-based care and consumer engagement
-
Reducing health disparities, particularly in underserved communities
-
Modernizing the care delivery system, including strengthening primary
care
-
Designing payment reform strategies that better support physicians,
hospitals, and other providers in delivering high quality
patient-centered care
-
Modernizing Medicare, including chronic disease management
-
Developing practical cost-containment strategies to slow the growth of
U.S. health care costs www.unitedhealthgroup.com/reform
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