Biotechnology Monitor & Survey Provides Broad, Comparative Profile of How Health Care Industry Is Managing and Planning for Growing Use of Biologic Therapies
New Survey Research Offers Insights into Pharmacy and Medical Benefit Management Strategies
(PRINCETON, N.J., May 1) – The use of state-of-the-art biologic therapies is rapidly increasing across multiple therapeutic categories. According to recent survey information, in 2007, new prescriptions for innovative biologics grew most among physicians treating Crohn’s disease, multiple sclerosis, cancer, rheumatoid arthritis, and psoriasis. A broad range of biotechnology marketplace practices was reported in the recently released 2008 Biotechnology Monitor & Survey: Marketplace Policies, Practices, and Perspectives. The research was sponsored by Bristol-Myers Squibb and conducted by an independent consulting firm, Emron, located in Wayne, NJ, which also prepared the survey analysis and developed the publication.
This is the publication’s first year, but the investigation into practices of five key stakeholder groups is expected to continue over the coming years to build trendable data points on the management and use of innovative biologic therapies. Such medications are now available for a rapidly growing number of medical conditions and diseases and more are in pharmaceutical pipelines. The groups surveyed were health plans, pharmacy benefit management (PBM) organizations, Specialty Pharmacy organizations, employers, and physician specialists (oncologists and rheumatologists).
Results from surveys of the multiple groups allow analysis of differences in approach to this new biopharmaceutical marketplace, and also show the management practices that have found a level of acceptance across several market segments. For example, one management trend these survey participants expect to increase dramatically is the use of physician evaluations—the profiling of physician prescribing practices focused on specific biologic treatments. In 2007, only 5 percent of commercial and group health plans had this kind of program in place to manage biologics, but between 2008 and 2010, an additional 30 percent of plans, 54 percent of rheumatologists, and 56 percent of oncologists expect to be taking part in physician evaluation programs linked to clinical outcomes of prescribed biologics. Eighty-seven percent of the plans expect the program to include some type of reimbursement component to reward physicians who follow guidelines.
Researchers also found that management techniques are already in place to share the costs of these complex new drugs with patients who use them. In 2007, commercial/group health plans were actively managing costs of biologic therapy by applying patient cost-share requirements for drugs covered under the pharmacy benefit that have—up until recent years—only been seen in medical benefit coverage. This survey showed that about 53 percent of plans are applying a deductible to biologics under the pharmacy benefit and 42 percent apply a maximum benefit cap on prescription drug benefits for biologic agents. Such techniques help shift some percentage of costs to the patient. A covered patient’s share of his or her biologic drug costs in 2007 was estimated by these survey groups to range from an average of 10 percent to 23 percent.
In comparison to commercial/group plans, Medicare Advantage plans depend more on management techniques that use educational and informational outreach to plan members and physicians. In 2008, 42.9 percent of Medicare Advantage plans plan to launch a new case management program for biologics and provide cost-of regimen information to providers; 23.4 percent and 28.6 percent, respectively, of commercial plans plan to use those two strategies. Half of Medicare Advantage plans plan to provide new biologic treatment protocols to providers in 2008, compared to 25.5 percent of commercial plans.
A cross-stakeholder editorial board directed the development of the publication and data analysis. In mid-April, one member of this board, Steven G. Avey, M.S, R.Ph., presented key findings from the survey at the Academy of Managed Care Pharmacy’s 20th Anniversary Annual Meeting in San Francisco, California. Mr. Avey is vice president of managed care for Partners Rx Management LLC, a PBM in Scottsdale, Arizona.
About the Biotechnology Monitor & Survey
The publication’s findings are based on survey data from hundreds of health care industry directors in five key areas:
- Health plans (commercial groups, Medicare Advantage plans, and managed Medicaid plans)
- Employer sponsors of health benefits (large self-insured employers and employer purchasing coalitions)
- Pharmacy benefit management organizations
- Specialty pharmacy provider organizations
- Physician specialists (oncologists and rheumatologists)
The publication supplements survey data with investigative articles that explore industry trends integral to the future of a therapeutically sound, cost-effective, sustainable market for these innovative medicines. Topics covered in articles and by survey reports include:
- Trends in the Management of Biologic Therapies
- Use of Biologics
- Use of Protocols and Guidelines
- Reimbursement and Financing
- Value Assessment
- Pay-for-Performance Initiatives in Oncology
- Management Trends and Predictions
- 2007: The Year in Review
- The Promise and Cost of Innovative Biologic Therapies
Beginning in June, additional research data compiled through the survey will be posted on the publication’s Web site – http://www.biotechmonitor.com. For further information, the editorial board can be reached through Emron at 973-321-4419. Contact(s):