The Magellan Rx Management Specialty Summit was held recently in New York City. RJ Health Systems’ very own Paul Rector was in attendance listening and connecting with thought leadership in the specialty drug space. Nationally-recognized payors, oncologists, and industry leaders explored and discussed the key issues, challenges and emerging trends facing an evolving specialty market ranging from clinical considerations and specialty drug management to payor trends and the future of oncology.
The highlight of the conference was a Payor panel on Medical Pharmacy. Panelists featured were Scott McClelland, PharmD, RPh, CHIE, Senior Director of Pharmacy, Commercial Programs and Specialty Management, Florida Blue, Bryan Amick, PharmD, MS, MBA, Pharmacy Director and Director of Clinical Quality & Population Health, South Carolina Department of Health and Human Services, Sheila Arquette, RPh, Director of Pharmacy Services, Independent Health and Pat Gill, RPh, Director & Chief Pharmacy Officer, Horizon Blue Cross Blue Shield of New Jersey. The discussion was lively and the four industry experts all agreed on two priorities for managing the drug trend:
- Approaching the trend holistically and managing medications across the organization, not tying to one budget line or another. Realizing that when you endorse something on one side of the benefit equation, it has impacts (consequences) on other side. You can’t just push financials back-and-forth and expect to make an impact.
- You must clean up your data so you can conduct proper analytics for providing support to case managers that lack clinical expertise when evaluating Medical Rx claims, checking if policies are actually being followed-through, and formulary design on Medical side.
The first point seemed to be greeted with skepticism as the silos of these organization are deep-seated, but the second was universally nodded along with by the panel.
A couple of interesting stats presented during the conference:
- In 2014, Medical Pharmacy spend represents $21.07 PMPM (vs. $15.57 in 2010), an increase of 35%, for Commercial Health Care and $44.99 for Medicare.
- Top 25 drugs by spend on Medical Benefit represent 65% of payer cost for commercial. ($13.70 of $21.07 PMPM). Oncology is 52% of this amount.
- Medicare – $31.27 PMPM from top 25 drugs (out of $44.99)
- Commercial Health Care – Remicade, Neulasta, Avastin, Rituxan are top 4 drugs (ranging from $1 to $1.79 PMPM each)
This year’s Magellan Rx Management Specialty Summit presented invaluable information and resources for those monitoring the specialty drug space. RJ Health Systems looks forward to attending the conference next year.