Medco strengthens specialty drug management

Medco is partnering with pharmacy software company NovoLogix to create a new medical benefit management program that is supposed to help control costs for expensive specialty drugs, which are used to treat rare or complex medical conditions.

According to a press statement from Medco, "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."

Medco and its subsidiary Accredo Health Group, Inc. have been working together to shift coverage of specialty drugs to the pharmacy benefit to "gain a better handle on their costs." With the new medical benefit management, Medco hopes to now provide greater cost transparency to health plans and employers that wish to continue coverage of specialty drugs under their medical plans.

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.

"We are very excited about our partnership with Medco," said 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."


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