Introduce Step Therapy to Help Control Specialty Drug Costs

January 18, 2013

Ritu Malhotra, PharmD., National Pharmacy Benefits Practice Leader  for The Segal Company, says that, “Employer-sponsored health plans that implement step therapy programs can see reductions in specialty pharmacy expenses.” Dr. Malhotra explains that there can be least five-to-ten similar medications in a therapeutic class, and physicians can be encouraged to begin a patient’s treatment for a medical condition with the lowest cost medication in the appropriate class, then step up to a higher priced medicine, only if necessary. “In fact,” Malhotra says, “more plan sponsors are now designing their programs to require the use of lower cost, clinically appropriate medications in the same class prior to authorizing higher priced or specialty drugs.”

While this strategy may not help slow cost trend for specialty medications, as an ever-increasing number of people with chronic, complex conditions are utilizing the costly specialty drugs available to treat them, step therapy is an effective clinical management program for plans seeking to control costs while maintaining high levels of access and availability of key medications to plan participants.

“It’s important for plan sponsors to get on the front end of this,” says Malhotra. “Implement a step therapy program now, and there is likely to be less disruption to participants later.”

For more information, or to speak with Ritu Malhotra about this topic, please contact Mary Feldman.

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The Segal Company (www.segalco.com) is an independent, US-based firm of benefit, compensation and human resources consultants. Clients include joint boards of trustees administering pension and health and welfare plans under the Taft-Hartley Act, corporations, non-profit organizations, professional service firms and state and local governments.

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