Variability and growth in spending for outpatient specialty pharmaceuticals.
Specialty pharmaceuticals are a unique group of drug agents used to treat complex clinical conditions. Many specialty pharmaceuticals are biological in nature and administered through injection or infusion. Tracking spending on these pharmaceuticals is complex, because these products may be processed as either medical or pharmacy claims. This benchmarking study of ten Blue Cross Blue Shield plans, representing almost eighteen million covered lives, documents large expenditures on select specialty pharmaceutical categories and much variation in spending across plans, age groups, and time. Our results underscore the need for insurers to scrutinize trends in specialty pharmaceutical spending and identify appropriate management strategies.
Mullins
C Daniel
CD
University of Maryland School of Pharmacy in Baltimore, USA. dmullins@rx.umaryland.edu
DeVries
Andrea R
AR
Hsu
Van Doren
VD
Meng
Fanlun
F
Palumbo
Francis B
FB
D000328:Adult; D000367:Age Factors; D000368:Aged; D000911:Antibodies, Monoclonal; D019985:Benchmarking; D054598:Blue Cross Blue Shield Insurance Plans / Q000191:economics*; D002626:Chemistry, Pharmaceutical / Q000191:economics / Q000639:trends*; D016527:Drug Costs / Q000639:trends*; D004791:Enzyme Inhibitors; D019538:Health Care Surveys; D006401:Hematologic Agents; D006801:Humans; D007345:Insurance Claim Review; D007356:Insurance, Pharmaceutical Services / Q000706:statistics & numerical data*; D007372:Interferons; D008875:Middle Aged; D010594:Pharmacies / Q000191:economics*; D013678:Technology, Pharmaceutical / Q000191:economics / Q000639:trends*; D014481:United States
D000911:Antibodies, Monoclonal; D004791:Enzyme Inhibitors; D006401:Hematologic Agents; D007372:Interferons