Bridging the gap between the hospital and alternate-site care Volume 3 • Number 2 • Spring 2014 • specialtypharmacycontinuum.com
In This Issue Ask the Expert
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Elizabeth Whalley Buono offers takeaways from the recent international summit on adherence.
Obamacare May Raise Patient Costs For Specialty Drugs
Ensuring mutual benefit can be tricky
In ACO Dance, Who Leads, Who Follows?
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atients who rely on expensive specialty drugs to treat their rare and complex conditions may be forced to pay a steep percentage of the drug’s cost in lieu of a traditional, fixed copay if they are in an Affordable Care Act (ACA) exchange health plan, according to specialty pharmacy experts. Despite the allure of lower monthly premiums with some of the exchange plans, consumers should brace themselves for higher deductibles and unpredictable out-of-pocket (OOP) costs that are increasing underinsurance and forcing some patients to abandon their new
Policy
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Specialty distributors are ready in wake of Otezla approval.
Clinical
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In this issue’s Disease State Spotlight, Diplomat’s Hetty Lima provides an overview of hemophilia management.
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see PATIENT COSTS, page 10
Operations & Mgmt
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Ensuring temperature integrity of specialty drugs, Part 2 of a Series
Educational Review Medication Errors: A Year in Review See insert after page 28.
Corporate Spotlight Omnicare Specialty Care Group
See page 21.
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pecialty pharmacy hasn’t been a big player in accountable care organizations (ACOs) so far, but that could change very soon, said Leigh Ann Bruhn, the director of reimbursement for health care consultancy Avalere Health, during the most recent of a series of webinars on what the growth of ACOs means for specialty pharmacy. There are now more than 500 ACOs in the United States—a number that is steadily increasing, according to a Premier Inc, survey of hospital executives released in December 2013. (The survey estimates that about half of all hospitals will be participating in an ACO by the end of 2014). These networks of doctors, hospitals and health systems, and other health care providers—usually with a primary care physician or practice at the hub—have a “pool” of people for whose health care needs they are jointly accountable. There are financial incentives for keeping patients healthy and out
of the hospital—carrots if you meet certain benchmarks on quality, prevention and costs, sticks if you don’t. During the March 19 webinar, cohosted by Avalere, Armada Healthcare and the Specialty Pharmacy Association of America, expert panelists focused on strategies for integrating specialty pharmacy into ACOs.
Latest Hepatitis C Guidelines Raise Payor Concerns
“ACOs and ACO-like entities are really looking for partners that can help them achieve quality goals, but pharmacy is not necessarily top of mind for them,” Ms. Bruhn noted during the webinar. The managed care organizations—especially the Medicare ACOs—are focused instead on partners they think can help them deal effectively with hot-button issues such as hospital readmission rates, which can result in big penalties when they are higher than expected.
Tampa, Fla.—New guidelines for hepatitis C treatment issued at the end of January—the first to incorporate the antiviral agents sofosbuvir and simeprevir, which were approved by the FDA at the end of 2013—have many payors in need of antianxiety medications of their own. A lack of clear patient selection criteria for the new medications and a projected $600 million bump in annual drug costs for larger plans that agree to cover the costly drugs are among the reasons why the treatment guidelines—by the American Association for the Study of Liver Diseases (AASLD), the Infectious Diseases Society of America (IDSA) and the International Antiviral Society-USA (IAS-USA)—are giving payors the jitters.
see ACO DANCE, page 12
see HEP C GUIDELINES, page 8
Collaborating on Quality
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