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The Explosive Specialty Pharmaceuticals Market: Who Gets, Who Pays, Who Decides?

It is estimated that spending on specialty pharmaceuticals will climb to more than 40 percent of total drug spend by 2030¹. This new pharmaceutical category raises important questions for the health care system, including who controls patient access to these expensive drugs and who should pay for them.

Slowing the Impact: The Role of Specialty Pharmacy in Managing Progressive and Chronic Diseases provides unique perspectives and recommendations from a diverse group of experts. This white paper is based on the proceedings of a groundbreaking multidisciplinary roundtable discussion that explored specialty pharmacy issues. Moderated by Susan Dentzer, editor in chief of Health Affairs, the roundtable featured a panel of experts from clinical practice, disease and patient advocacy, bioethics, the pharmaceutical industry and pharmacy benefits management, as well as a person living with multiple sclerosis.

Despite the diversity of the experts, the white paper reveals many points of consensus around specialty pharmaceuticals in the face of rising health care costs. These include bringing patients into the decision-making process about treatment and costs; enhancing knowledge about drug efficacy and safety; and questioning allocation of resources.

"Patient education is important in understanding evidence-based medicine, reducing costs, and figuring out programs to get the right people the right treatments," said Jacqueline Kosecoff, Ph.D., CEO of Prescription Solutions and one of the roundtable experts. "People with chronic and serious diseases need help with follow-through so they can experience the value of not only the specialty medication, but also the high-touch care involved in treating their conditions, such as counseling, transportation assistance, and other social support services."

Also known as biologics, specialty pharmaceuticals are used to treat serious or chronic medical conditions such as multiple sclerosis, cancer, hemophilia, HIV and rheumatoid arthritis. These drugs offer enormous clinical value and profound hope to millions of patients in need. Many of the approximately 57 million working-age Americans living with these diseases² depend on these highly effective drugs to continue working and to be productive members of their communities. However, the high costs, special handling requirements and adherence challenges associated with specialty pharmaceuticals pose serious questions about their impact on health care and the roles and responsibilities of all those involved in their delivery and uptake.

Slowing the Impact outlines recommendations to address these challenges, including the need to convene more stakeholder forums; better engagement of patients in managing their own health; a commitment to data collection and data sharing; and leveraging successful health delivery models to make care more accessible, affordable and of higher quality. The recommendation that enjoyed the broadest and deepest support was the creation of national patient registries, which have proved valuable for other medical specialties such as pediatric oncology. The experts also agreed that establishing multimedia public information programs would broaden awareness and knowledge of specific diseases and treatment options.

The experts whose perspectives and challenging questions appear in Slowing the Impact include Dr. Kosecoff; Nancy Berlinger, Ph.D., Deputy Director and Research Scholar, The Hastings Center; J. Ross Maclean, M.D., MBA, Vice President, Health Services, Bristol-Myers Squibb; Lee N. Newcomer M.D., Senior Vice President of Oncology, Women's Health and Genetics, UnitedHealthcare; P.J. Weiner, Senior Manager, Advocacy Programs, National Multiple Sclerosis (MS) Society-NY; and Kenneth Bandler, MS patient and patient advocate.

The white paper is being made available by Prescription Solutions, a leading pharmacy benefits management organization and UnitedHealth Group (NYSE: UNH) company, which sponsored the expert roundtable. The paper can be downloaded here.

About Prescription Solutions
Prescription Solutions is an innovative pharmacy benefit management company managing the prescription drug benefit of commercial, Medicare and other governmental health plans, as well as those of employers and unions. A UnitedHealth Group company, Prescription Solutions serves customers through a national network of 64,000 community pharmacies and state-of-the-art mail service pharmacies in Carlsbad, Calif., and Overland Park, Kan., both of which have earned the prestigious Verified Internet Pharmacy Practice Sites (VIPPS) accreditation by the National Association of Boards of Pharmacy (NABP). Prescription Solutions also won a Platinum Award for URAC's Best Practices for Consumer Empowerment and Protection Awards for the Multiple Sclerosis Disease Therapy Management Program (2010); and two Silver Awards: the Drug Interaction Alert Program (2009) and Geriatric RxMonitor Program (2008). Additional information can be found at www.prescriptionsolutions.com.

About UnitedHealth Group
UnitedHealth Group is a diversified health and well-being company dedicated to helping people live healthier lives and making health care work better. With headquarters in Minnetonka, Minn., UnitedHealth Group offers a broad spectrum of products and services through six operating businesses: UnitedHealthcare Employer & Individual, UnitedHealthcare Medicare & Retirement, UnitedHealthcare Community & State, OptumHealth, Ingenix and Prescription Solutions. Through its family of businesses, UnitedHealth Group serves more than 75 million people worldwide. Visit www.unitedhealthgroup.com for more information.

¹ Specialty Pharmacy: Stakeholders, Strategies and Markets Third Edition, 2008 AIS
² Center for Studying Health System Change, 2003 Community Tracking Study (CTS) Household Survey.

Prescription Solutions
David Himmel, 714-226-3772
david.himmel@prescriptionsolutions.com