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Low-volume, high-cost biotech or injectable drugs are being used increasingly to treat complex (often chronic) diseases. In many cases, their successes are legendary, and the FDA pipeline promises to produce many more in the years ahead.

The cost of specialty pharmacy services can range from a few hundred dollars to tens of thousands of dollars per dose, and up to $200,000 per patient per year. For members with chronic conditions like hemophilia, infertility, cancer and multiple sclerosis, they can cost $1,000 or more per member per month, consuming a large portion of the plan's medical and pharmacy budget.

These new costs must be managed carefully, but delivering biotech or injectable drugs to patients (and related insurance issues) can be far more complicated:

Specialty pharmacy providers (SPPs) are a new breed of company that is having an ever-bigger impact on the delivery and administration of these drugs. Many managed care decision makers need effective strategies for managing specialty pharmacy services and a better understanding of the capabilities of different types of SPPs.

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Let two of the nation's experts on specialty pharmacy programs help you assess the pros and cons of health plan options for delivering high-cost, low-volume biotech drugs and injectables.

Debra J. Stern, R.Ph., is Vice President of Irvine, Calif.-based Rxperts Managed Care Consultants, Inc., where she is responsible for designing and implementing comprehensive programs to meet the needs of managed care clients. Previously, she was the director of pharmacy services at Prescription Solutions. Ms. Stern also is actively involved in the Academy of Managed Care Pharmacy, where she has recently completed a two-year term on the Board of Directors.

John Rodgers, R.Ph., M.B.A., is the Director of Pharmacy for Independent Health, a Buffalo, NY-based health plan with 400,000 members. Mr. Rodgers recently designed a specialty pharmacy program for the insurer, including contracting with an outside vendor to distribute and manage specialty drugs.

Moderator: Jill Brown, managing editor of AIS's industry-leading Managed Care Week.

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Written Materials

Audiotape purchasers will receive valuable written materials on specialty pharmacy programs and health plan options for delivering high-cost biotech and injectable drugs.

Related Publications

Drug Benefit News
Managed Care Week