Specialty drug management programs are complex by nature with disparate multiple stakeholders. Increasing availability and cost of specialty drugs create an unsustainable financial burden for payers. How do you most effectively integrate and manage the many detailed program components, organizations, and tactics? Combining your core strategies that you previously implemented from our Combat Specialty Drug Cost Trends with Utilization Management blog post, with these four optimizing strategies offers an ideal approach to managing specialty drug costs while assuring appropriate patient access wherever possible.

1. Really Understand Your Population, Market and Economics to Inform Your Management Strategy

It is critical for the payer to understand the cost, efficacy and potential cost savings or offsets from prescribing a specialty drug to various patient populations in order to determine whether to facilitate patient access to the drug at all, and if so, at what payer price and patient cost, and through what mechanism or channel to offer it.

Such research should provide an understanding of not only real but also market perceptions of efficacy, value, costs and benefits, competitor directions and approaches, etc. by target population. There are exciting new approaches and supporting tools for this work, including expert crowd-sourcing and powerful new statistical survey techniques combined with state of the art computing capability.

General market research must then inform individual employer or accountable population planning. This should be done first at a segment level – for various types of employer populations with similar demographic profiles. This work should drive overall specialty drug management program design. Finally, the focus should be on customized program implementation approach for individual benefit plan membership groups – typically at the employer level.

2. Enhance Data-Driven Performance Management

There is too much as stake given the cost of specialty drugs to not have a clear and accurate understanding of how your specialty drug management program is performing at all times. And, at least as importantly, it is critical to know why the program is performing as it is. Define the financial, quality, service, and compliance performance objectives of your program in detail and the associated metrics and target values that will demonstrate success. Utilize state of the art techniques borrowed from business intelligence disciplines to create, collect, report, and analyze data to describe performance, predict future performance, and prescribe actionable initiatives to improve performance.

3. Formalize Specialty Drug Program Management

Properly designing, implementing, and managing a specialty drug program as a payer – including programs involving direct supplier-to-employer contracts – is a complex undertaking. It requires coordination of resources, strategies, and tactics across multiple internal and external organizational functions and enterprises. The very significant resources at stake combined with the potential political ramifications across the market require a formal and comprehensive program management approach.

This approach often starts with development of a robust business case with a clear return-on-investment for a formal specialty drug management program. A program with this level of complexity and cost implication requires a dedicated leader with both high-level expertise as well as access to key decision makers. This leader should be supported by appropriate direct staff, as required. There should be clear program accountability to performance objectives, and tools and processes to measure, report, analyze, and support program performance.

4. Get Expert Help If Needed

Understanding the interoperation of all the components and players to inform program design requires significant and varied expertise and experience. And program design and implementation take dedicated resources. Most organizations don’t have the required expertise in sufficient capacity to effectively re-purpose to create, implement, and operate such a program. Investment in expert consulting for program research, design, and implementation can very cost-effectively pave the way for permanent staffing for program operation and management.

Building on operational experience, we’ve extensively analyzed the numbers and trends on traditional vs. specialty drug spending and availability, and effectively outlined for you: 4 core strategies for payers to take on the challenge of managing cost and access to specialty drugs, 4 optimizing strategies to take on the challenge of specialty drug program design and management, , and how to optimally invest your resources to sustain specialty drug management program performance objectives. Download the free ebook now!

Payer Strategies for Specialty Drug Management free eBook