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Medco Launches Medical Benefit Management Program To Better Manage Specialty Drug Spending, Coverage Needs

Stocks in this article: MHS

"We are very excited about our partnership with Medco," says David McLean, CEO of NovoLogix.  "We will provide our technologies and experience in this program with Medco to bring significant value to health insurers and payors to help stem the double digit cost trends that plans and patients are experiencing."

Under the medical benefit management program, Medco will oversee medical policy development, formulary management, prior authorization and coverage rule management, claims management including NDC-based pricing and rebate management for clients. .  This program will coordinate the coverage of these medicines whether Accredo dispenses them to patients or if they are dispensed in a physician's office or another outpatient setting.  Many of these medications have special handling requirements and potentially severe side-effects, demanding a heightened level of interaction between the patient and the clinical team overseeing care.

Major medical plans often have limited means to manage the channel of specialty drugs, which include treatments for cancer, HIV, hemophilia, rheumatoid arthritis, multiple sclerosis and other complex medical conditions.  The emergence of these medications during the past decade has escalated the annual cost of these drugs, which start at approximately $6,000 and reach as high as hundreds of thousands of dollars for treatments of rare conditions.  Accredo focuses on ensuring these medicines are used correctly; it also works to limit waste, coordinates coverage, and engages clinicians about the care being provided for those receiving specialty drugs. 

Proper management of specialty drugs is essential given their tremendous costs.  The drug trend in this category grew 17.4 percent in 2010, the fastest pace since 2004. Utilization of specialty drugs grew almost three times faster than overall utilization. Specialty unit cost grew more than seven times faster than overall unit costs.  The expanded patient populations of these drugs is one of the variables that drove the 5.9 percent utilization increase seen in 2010.  Unit cost increases for these drugs surged 11.5 percent during 2010.

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