EMD Serono Specialty Digest shows more interest in site of care by payers


14th edition attracted 59 commercial plans as respondents, representing 100 million lives

The 14th edition EMD Serono’s Specialty Digest continues its insights into the worries of pharmacy directors at managed care organizations and health plans. This year, the Digest took a particular look at multiple sclerosis (one of EMD Serono’s product areas) as well.

According to respondents, managing costs and evaluating value are the key drivers overall—no surprise there. Despite high interest, 25% of respondents noted that “determining value of specialty drugs” was their least successful goal to be achieved in the past year; conversely, “ensuring clinically appropriate use” was their most successful goal. There is a mixed message regarding the entrance of biosimilars: While the expectation of seeing prices 25% below those of the originator products has faded (only 3% of respondents expect this), respondents upped their expected cost savings from 6% in 2016 to 9% in 2017.

Among other results noted from the respondents:

  • Payer strategies to manage specialty drugs: Since 2013, there has been a 135% increase in health plans that are using site-of-care programs - hospitals, community offices, ambulatory infusion suites, or home-based settings. Of those that do not have a site-of-care program, more than half plan to implement one in the next 12 months.
  • Challenges and opportunities in oncology: Today, 84% of plans now collaborate with physicians, including oncologists, to develop cancer treatment pathways, while only 38% did so in 2016; Plans are now concentrating on collaborating rather than solely focusing on use of third party organizations and/or internally-developed pathways.
  • Benefits assessment for multiple sclerosis (MS): 76% of plans cover injectable drugs under the pharmacy benefit only. Furthermore, most plans (78%) require injectable drugs for MS to be dispensed through a contracted specialty pharmacy provider (SPP).

"This year's Specialty Digest reveals noteworthy findings – particularly the increase of infusion site-of-care programs and rise in physician collaboration for cancer treatment development – that we believe will serve as an important benchmarking tool in this highly complex managed care environment," said Robert Truckenmiller, SVP, market access & customer solutions.

The survey was conducted during October-November, 2017, to “commercial health plan personnel who are responsible for specialty drug-related services.” The full report is available at http://specialtydigest.emdserono.com.

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