Audio CD and written materials of AIS's audioconference on December 7, 2006

Managing Rheumatoid Arthritis: Strategies for Health Plans

With about 2.5 million people suffering from rheumatoid arthritis and annual U.S. expenditures of almost $8 billion, RA management strategies should be a top priority for every health plan. In addition to the dollars and populations at stake, the condition has complicated issues related to reimbursement and benefit design, including the number of specialty therapies that are indicated for RA as well as other autoimmune disorders. Find out what strategies health plans are employing to improve outcomes and reduce costs, which should trend even higher with expensive new RA drugs in the pipeline.

Sponsored by Atlantic Information Services, Inc., publisher of Specialty Pharmacy News, Drug Benefit News and Managed Care Week

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In their most recent drug trend reports, the "big three" PBMs — Caremark Rx, Inc., Express Scripts, Inc. and Medco Health Solutions, Inc. — ranked anti-inflammatories or rheumatological drugs in their top 10 drug classes that contributed to spending growth in 2005. Recent estimates project the RA market will increase to approximately $13 billion by 2011.

RA treatments range from over-the-counter pain medication to nonsteroidal anti-inflammatory drugs (NSAIDs) to specialty therapies. Annual treatment costs for these biologics can approach $20,000 per patient, and many plans require forms of utilization management such as prior authorization and formulary tiers. Off-label use tends to be high for these drugs as well.

Besides RA, most of the specialty drugs are approved for other inflammatory conditions, such as psoriasis and Crohn's disease. The range of indications can be problematic for health plans, which often have a difficult time tracking the drugs' usage.

As some of the treatments are physician administered, reimbursement can be through either the medical benefit or the pharmacy benefit, which can lead to additional tracking difficulties. Further complicating RA management is the fact that the treatments can have significant side effects, including tuberculosis, so patient monitoring must occur.

Add to all of these factors the array of NSAIDs and specialty drugs in the pipeline, and the RA market stands to have an even bigger financial impact on payers than it already does.

Hear two industry leaders guide you through:

Speakers

HELEN SHERMAN, R.Ph., Pharm.D., is director of pharmacy services at The Regence Group's RegenceRx, a not-for-profit PBM whose evidence-based research program makes it a national leader in assessing the value of medications, reducing pharmacy trends and increasing generic utilization. Regence serves about 2.6 million members of Blue Cross/Blue Shield plans in Oregon, Washington state, Utah and Idaho. Dr. Sherman, who joined RegenceRx in 1996, is responsible for the company's scientific review process, and also develops educational information/tools for consumers and doctors and facilitates benefit design. She has more than 20 years of experience in managed care, retail, hospital, home care and community research settings. Dr. Sherman earned her bachelor's degree in pharmacy from Oregon State University and her Pharm.D. from Purdue University, and she is a member of the Academy of Managed Care Pharmacy.

DEBBIE STERN, R.Ph., is vice president of Rxperts, a managed care consulting firm in Irvine, Calif., where she is responsible for designing and implementing comprehensive programs to meet the needs of managed care clients. She has recently devoted considerable time to projects related to specialty pharmacy for all segments of the health care industry. In addition to 12 years of managed care experience, Ms. Stern spent five years in the pharmaceutical industry and 10 years in retail pharmacy. She has a B.S. in pharmacy from the University of Cincinnati and is actively involved in the Academy of Managed Care Pharmacy, where she recently completed a two-year term on the board of directors.

Moderator: Angela Maas, managing editor of AIS's Specialty Pharmacy News and editor of Drug Benefit News

 

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