So with regard to how brokers/advisors and employers can manage spend, achieving the best therapy at the lowest cost requires three things:

Utilization management: Good discounts and rebates will not make up for paying for a medication that is not appropriate. Having an independent prior authorization process that engages with the prescriber to collect appropriate medical history is essential. The difference between an independent review process and an automated Prior Authorization process produces a 20% to 25% difference in overall approval rates. In addition, an independent process will identify opportunities for lowering cost on parity priced medications and medications that are dosed based on the patient's weight. For example, four 1mg Pomalyst tablets have an annual cost of $960,000, whereas one 4mg tablet has a cost of $240,000/year — a savings of $720,000. Most prescribers would not be aware of this and an automated Prior Authorization process would not typically catch this.

Purchasing: When a product is appropriate, get the lowest cost possible by applying the most competitive discounts, rebates and when available manufacturer copay assistance program discounts.

Ensure appropriate response: An individual's response to therapy can change over time. Paying for a medication that isn't well tolerated or is not producing the desired response will only lead to treatment failure and delay effective treatment.

Instant Insights /

Specialty medications Q&A: key trends and strategies for brokers and employers