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The Rise of Specialty Pharmaceuticals

April 24, 2013
Fact: Specialty pharmaceuticals represented nearly 25 percent of all drug spending last year.

By 2018, it’s estimated they’ll account for nearly half of the 100 top-selling medications on the market. With an average cost for a specialty medical therapy hovering around $35,000 to $75,000 per patient per year, this is an area that is getting the attention of top industry players - from biopharma who see the market opportunity to healthcare payors like health plans and large employers who need to find a way to fund the need for patients around the globe.

Over one-third of all specialty drugs currently in development – and there are nearly 900 of them – target cancer and related conditions, which is by far the most concentrated area of research. But specialty drugs manage many other complex, chronic conditions including HIV, Multiple Sclerosis, Hepatitis C and Crohn’s Disease.

At Catamaran, our primary responsibility as a pharmacy benefit manager is to help payors manage the escalating costs of healthcare so they can continue to offer effective and affordable services to patients. With specialty pharmaceuticals being a major growth engine behind the trend of increased drug utilization, payors cannot begin to even conceptualize or manage the associated cost without the assistance of a specialty pharmacy network and tools designed to curtail these rising drugs costs. Catamaran’s specialty offering, BriovaRx, does just that by addressing two major elements of the equation: deliver savings to clients (payors) and provide individualized care to patients.

We believe a more streamlined, coordinated delivery model will reduce fraud, waste and abuse and empower not only patients, but the physicians who prescribe the drugs, and the pharmaceutical companies that make them.  It is under this premise that the Affordable Care Act is creating new payment and delivery models designed to promote more efficient, affordable healthcare in the United States.  This is all through a more educated, connected community of stakeholders grounded in technology, innovation and the idea of consumer self-service.

While this will help create healthier communities, it will also raise national health expenditures on prescription drugs from $330 billion in 2012 to an estimated $483 billion by 2021. In addition, 30 to 40 million more individuals will be eligible for much needed healthcare coverage.  How we fund the healthcare dollar will continue to be debated, and we all have skin in the game: the biotechnology pharmaceutical industry, the PBM and payor community, physicans and consumers.   It was this debate that was discussed during the BIO International Convention panel discussion, Finding Common Ground: Can Payers and Biopharma Agree on Therapeutic Value?

Albert Thigpen is Senior Vice President of Pharmacy Operations and Industry Relations with Catamaran.