Getting diagnosed with a complex condition like multiple sclerosis, cancer or a rare genetic disorder can be incredibly stressful, and patients often have significant questions and concerns. Living with these conditions involves managing complicated medication regimens while also dealing with sometimes severe symptoms, side-effects and the impact to their lifestyle. Not surprisingly, for many patients, this can be overwhelming.
Treating these conditions is often expensive, costing tens, if not hundreds of thousands of dollars a year. And the price tags for new specialty therapies have continued to climb. Data from CVS Caremark shows that 52 percent of the total client spend on pharmacy benefits comes from just 2.5 percent of members who use specialty treatments. The cost of these medications is a significant challenge for employers and patients alike. In recent years, niche vendors have entered the market, luring employers with promises of large savings if they “carve out” specialty pharmacy services from integrated pharmacy benefit managers (PBMs).
But such approaches not only fail to deliver on the overblown promises of savings, they can also jeopardize patient care and outcomes and lead to long-term costs by limiting care without clinical justification.