How well are specialty injectable drugs managed?

BACKGROUND: As relatively expensive specialty injectable pharmaceuticals have become increasingly available, associated cost-containment challenges have grown. PharmAnalysis Group conducted a survey to understand how managed care organizations are managing - or are planning to manage - injectable products. METHODS: In-depth telephone interviews were completed with medical or pharmacy directors at 83 MCOs in the United States that manage injectable drugs in some capacity. These MCOs included large national plans, large and small regional and local plans, Blue Cross Blue Shield plans, and Medicaid MCOs. RESULTS: Sixty-three MCOs included in the survey are managing injectable drugs, and 20 are planning to manage them. Management techniques vary from simple utilization controls to specific injectable-product distribution and reimbursement methodologies. Only 36 of the 83 MCOs (43.4 percent) in the survey include all injectable drugs in their managed injectable program, 62 (74.7 percent) MCOs utilize or plan to utilize either specialty pharmacy providers or pharmacy benefit managers for distribution of injectable drugs, and 39 (47.0 percent) MCOs eliminate or plan to eliminate the ability of the physician to purchase injectable products, bill for the product, and receive a profit. CONCLUSION: Management of injectable drugs has begun and will evolve as effective methods for cost control are developed. By understanding successful methods and how other organizations have implemented such methods, MCOs can help to ensure the success of the programs they develop to manage these products.