Blue Promise: Specialty Pharmaceuticals

Blue Promise: Specialty Pharmaceuticals


MUSIC DAN: Hello I’m
Dr. Dan McCoy and welcome to this
episode of Blue Promise
I’m here today with Dr Paul Hain
he is our Chief Medical Officer
for North Texas Blue Cross and Blue
Shield of Texas, so Paul, today I
wanted to talk a little bit about this
concept of specialty drugs and it’s one of those
things that probably as the Chief Medical Officer
makes me the most concerned because when
I look at the growth of both use and spend
of these drugs the curve is almost
straight up PAUL: It looks like
a hockey stick DAN: It does, so what
is a specialty drug? PAUL: There are lots of different definitions for what the specialty
drug is, probably the easiest one is one that
is simply many times more expensive than
your typical drug DAN: And often these
are drugs that are like I V or given in a physician’s office, self-administered
at home PAUL: A few come in
tablets but for the most part these are
injectable either by the patient
themselves or given an infusion by their physicians DAN: And often you
don’t get them at your local pharmacy, they are mailed
to you PAUL: These drugs are
so expensive and it’s so important to keep
tabs on every little bit of it often we have members go through what we call a specialty
pharmacy to get it by mail so that we’re sure
with these really important drugs they’re getting exactly the right amount, we’re getting
it from the right place so it cost the least amount possible because these are seriously expensive drugs and that folks are tolerating them well so
that we’re not using them in a way that we
shouldn’t be DAN: So it’s really easy when you talk about this speciality drug challenge to focus on the problems but these are, these
are life altering medicines PAUL: they are wonderful drugs, they give people their lives back.
I’m thrilled to be living in a time where
these kind of inventions have occurred but because they’re so expensive we have to be very judicious in how we use them because there really is
only so much money to go around and the more careful
we are with using them just when they need to be used, the more we can use them DAN: I have an interesting story, I am a Dermatologist and I had a young child who
come into my office, he was 19 at the time but he had never been in a public swimming pool because of psoriasis and we were able to use a specialty drug in
this child, a nineteen year old and for the very first time was able to go swimming in a public swimming pool
and enjoy his life so in effect, he got
his life back with a new but expensive medicine and that’s the challenge because these drugs cost a lot of money PAUL: They do they’re made often in very different ways from the old drugs
sometimes we call them biologics because they use DNA and special bacterial techniques to create these drugs which is a super expensive way to make a
drug but it also lets you really focus on very particular things that perhaps the pharmaceutical industry hasn’t been able to focus on before DAN: And it’s typically not one and you are done, right? These are chronic medicine so people tend to take them for a long time PAUL: A lot of these drugs for immune modulators if you have an immune disorder you take the rest of your life to stay normal so it’s very important to get it right in the beginning and keep it right DAN: So we’ve hinted around the edges a little bit about they are expensive, so
give me an example of what you’re talking
about how much PAUL: It could range from
as little as $20,000 a year up to 4 or $500,000 a year for the rest of your life DAN: I mean that’s that’s that’s incredible PAUL: That is DAN: So let me ask you some questions, then how would I manage that so how would I manage the costs because I’m gonna tell you when I hear numbers like that and I know what the cost of health care I mean that didn’t sound sustainable so how do we
how do we give people their life back and manage that so that they have these drugs available PAUL: So really the
most important thing to do is make sure
we’re only using these drugs and people were actually going to work so the first part of management is
making sure that it’s not over prescribed DAN: So it is expensive
to experiment around? PAUL: Exactly, the second
part is making sure you get it from a place that does a good job negotiating with the drug companies and specialty pharmacies that’s what they do, so
if you get it from a specialty pharmacy, you’re
going to be able to keep your what we
call, channel management correct you’re getting it from the right place getting it delivered to the right place which is either to the patient themselves or sometimes to the patient’s doctor when the doctor
needs to administer DAN: For the
right problem PAUL: exactly DAN: So it’s kinda those three combinations that help people? PAUL: And really the last part is important to get the drug from your doctor in the right place so if your doctor offers to give it to you in the doctor’s office as opposed to going to the hospital and getting it, there it’s much cheaper overall to get it in your doctor’s office so we encourage folks to look for docs who are
able to do that DAN:Thats great, thanks for educating us today on specially drugs, thanks for joining us for this episode of Blue Promise MUSIC

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