Filling a prescription for most pharmaceuticals is easily accomplished at the neighborhood pharmacy.
However, some medications for more serious and complex medical conditions have a higher list price. Unfortunately, these are drugs the local pharmacy typically does not carry.
That’s where specialty pharmacies come into play. This year, Gratiot-Isabella Regional Education Service District is making things easier for members who require the use of a specialty pharmacy company.
Specialty pharmacy drugs are those medications classified as high-cost and highly complex. This often includes biologics, which are injectable drugs becoming popular for conditions such as rheumatoid arthritis and types of psoriasis.
Medicare defines a specialty drug as any drug for which the negotiated price is $670 per month or more and is placed in a specialty tier that requires a higher patient cost sharing.
Through a new partnership with Walgreens, Gratiot-Isabella health plan members will be able to receive their specialty medicines from the AllianceRx Walgreens Prime program. The program will allow for medications that are self-administered and classified as specialty drugs that are not available at the neighborhood pharmacy to be shipped directly to the homes of RESD members. If members do not want the medication shipped to their homes, the AllianceRx program allows medications to be sent to the closest Walgreens retail store for pick-up.
The new program goes into effect on Sept. 1, says Melissa Ramos, an account executive with Brown & Brown of Central Michigan. The changes to the program only pertain to those drugs that are traditionally filled by specialty pharmacies, and only those that are self-administered by patients, Ramos explains. Those medications include drugs for cancer, multiple sclerosis, HIV, hemophilia, inflammatory bowel disease, rheumatoid arthritis and chronic kidney failure. Specialty drugs account for a significant percentage of new drug approvals by the U.S. Food and Drug Administration.
Gratiot-Isabella entered the Walgreens program was to save money, Ramos says. For several years, the upward trend in insurance premiums has been based on prescription drugs, particularly those classified as specialty drugs. Many specialty drugs have high list prices that can run into the tens of thousands of dollars for a course of treatment. Ramos notes some new medications that provide a virtual cure for hepatitis C have a list price of more than $30,000.
“In a self-funded group this can get really expensive, and the idea was to save funds on these specialty medications,” Ramos says.
Ramos adds that the new program is only for medications that are self-administered. For patients who require medications that are administered at infusion centers, nothing will change. Those patients will still go to the centers for treatment. Ramos adds that those medications are not typically covered through prescription benefit plans but covered under medical insurance programs.
While the change in specialty drugs is coming, Ramos says there are no other changes with benefits, so district clients will not have to worry about that. More information will be forthcoming to health plan members in August, ahead of the Sept. 1 start date.
