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AHIP: How insurers offset rising specialty drug costs


As specialty drug costs continue to rise, insurers are working to implement innovative strategies to offset those increased prices, while still helping their members gain access to important treatments, according to a new issue brief from America's Health Insurance Plans.

The insurance industry has been battling drug makers over pricey specialty medications like hepatitis C drug Sovaldi for months now, and have been adopting more cost-sharing measures to shift these drugs' expensive costs onto consumers, as FierceHealthPayer has reported.

Aetna, for example, has support teams that help members manage a range of conditions, including hepatitis C, arthritis and autoimmune disease, through personalized care programs. Additionally, members taking specialty meds receive information on copayment assistance programs and community support programs as well as other resources.

CareFirst Blue Cross Blue Shield's care coordinators work directly with members taking specialty drugs while staying in close contact with the providers. And with its "advanced, data-driven analytics," members are automatically entered into the specialty pharmacy coordination program when they fill a specialty drug prescription. Data from that program helps providers know about members' utilization and outcomes related to their meds.

Meanwhile, Cigna uses integrated condition-level therapy management program for its specialty pharmacy members. The insurer offers condition-specific fulfillment teams within its specialty pharmacy services as well as drug-specific coaching and support. Cigna also coordinates member outreach through a single engagement platform that allows all providers and coaches to connect with each other.

And Kaiser Permanente integrates its clinical and specialty pharmacy services with its robust IT tools, allowing the insurer to provide access to specialty drugs in a safe, effective and efficient manner. When Kaiser members get a specialty medication prescription filled, the pharmacist works with the prescribing doctor to ensure members are aware of possible risks. This practice helps Kaiser detect adverse medication effects earlier and helps boost members' medication adherence, adds the brief. 

To learn more:
- here's the AHIP issue brief

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AHIP slams pharma for taking advantage of insurers