A Review of Approaches for the Management of Specialty Pharmaceuticals in the United States

• Published in: PharmacoEconomics 2014-11, Vol.32 (11), p.1105-1114
• Main Authors: Patel, Bijal Nitin, Audet, Patricia R.
• Format: Article
• Language: English
• Subjects: Biological and medical sciences; Biological products; Biosimilar Pharmaceuticals - economics; Chronic illnesses; Cost control; Cost Control - trends; Costs; Drug Costs; Economic aspects; Economy. Management; Emerging markets; Evidence-based medicine; Evidence-Based Medicine - economics; Expenditures; General pharmacology; Health Administration; Health and social institutions; Health Care Costs - trends; Health care expenditures; Health care policy; Health care reform; Health Economics; Health insurance; Hepatitis; Humans; Innovations; Medical care; Medical sciences; Medicare; Medication Therapy Management - economics; Medicine; Medicine & Public Health; Miscellaneous; Oncology; Patient Protection and Affordable Care Act - economics; Pharmaceutical industry; Pharmaceutical Services - economics; Pharmaceuticals; Pharmacoeconomics and Health Outcomes; Pharmacology. Drug treatments; Prescription drug plans; Prescription drugs; Public Health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Quality of Life Research; R&D; Research & development; Review; Review Article; Specialty products; Studies; United States; Utilization
• ISSN: 1170-7690; 1179-2027
• DOI: 10.1007/s40273-014-0196-0

With increased innovation and development of specialty pharmaceuticals, the US and global healthcare industries are looking to implement appropriate management strategies to control both utilization and costs. Specialty pharmaceuticals are high-cost medications that treat complex, chronic, rare, and difficult-to-manage conditions. These drugs require special drug handling, appropriate clinical outcomes monitoring, and effective cost controls. The primary scope of this article is to discuss various strategies being implemented for specialty pharmaceutical utilization and cost management and correlated outcomes in the USA; these outcomes include enhanced health insurance plan benefit designs with formulary modifications and greater patient cost burden. Additional methods to manage specialty pharmaceuticals include the use of specialty pharmacies for drug distribution, increased emphasis on coordination of care and evidence-based medicine, as well as healthcare reform and regulations. Healthcare spending, both in the US and globally, continues to increase, with a rising proportion of drug spend towards specialty pharmaceuticals. Continued specialty pharmaceutical innovation and introduction of biosimilar products will evolve the currently utilized management strategies for these drugs.