Navigation Links
Intravenous Immune Biologics Will Suffer from the Pending Shift in Coverage from the Medical to the Pharmacy Benefit
Date:7/15/2009

NASHVILLE, Tenn. and GLEN ROCK, N.J., July 15 /PRNewswire/ -- HealthLeaders-InterStudy and Fingertip Formulary find that surveyed pharmacy directors of both national and single state plans say coverage of immune biologics will shift from a medical benefit to a pharmacy benefit by 2014, citing Centocor Ortho Biotech's Remicade and UCB's Cimzia among products that will be most affected by this shift. According to the new Formulary Forum report entitled Formulary Advantages in Immune Biologics: Tightening Payer Control Offers Opportunities for Differentiation, the majority of surveyed pharmacy directors say they currently cover Amgen/Wyeth's Enbrel and Abbott's Humira solely as a pharmacy benefit, but cover other immune biologics as a medical benefit.

The report finds that payers expect the shift of biologics from the medical benefit to the pharmacy benefit is motivated by an expectation of increased cost control. For example, 34 percent of surveyed payers currently require patients taking an IV biologic to first fail therapy with an SC biologic and will continue to enforce this requirement moving forward. An additional 38 percent of surveyed payers expect to newly implement this cost control measure over the next five years.

"Managed care organizations are looking to restrict patient access to physician-administered biologics, because these agents are harder to control in terms of cost outlays--in part due to physicians preferentially prescribing agents such as Remicade so the physician can purchase the agent at a discount relative to the reimbursement rate and thus maintain a profit margin on the procedure," said Michael Malecki, Ph.D., product manager for Formulary Forum. "Maintaining control of the supply chain will be critical to the future profitability of managed care organizations, and plans are aware of this fact. By 2014, for example, 84 percent of surveyed pharmacy directors say their organization will mandate IV biologics be purchased from an authorized vendor (e.g., specialty pharmacy)."

About Formulary Advantages in Immune Biologics: Tightening Payer Control Offers Opportunities for Differentiation

The new Formulary Forum report is based on a survey of 50 pharmacy directors who control national, regional and state-level managed care organizations, as well as historical formulary data from Fingertip Formulary.

About Fingertip Formulary

Fingertip Formulary (www.FingertipFormulary.com), the leading provider of access to and insight into formulary data in the United States, offers comprehensive formulary data covering commercial, Medicaid, Medicare and PBM plans, among others. The company offers a variety of unique data and marketing solutions for the pharmaceutical industry, consultants and healthcare providers that provide access to and insight into formulary data. Fingertip Formulary is a Decision Resources, Inc. company.

About HealthLeaders-InterStudy

HealthLeaders-InterStudy, a Decision Resources, Inc. company, is the authoritative source for managed care data, analysis and news. For more information, please visit www.HL-ISY.com.

About Decision Resources, Inc.

Decision Resources, Inc. is a cohesive portfolio of companies that offers best-in-class, high-value information and insights on important sectors of the healthcare industry. Clients rely on this analysis and data to make informed decisions. Both HealthLeaders-InterStudy and Fingertip Formulary are Decision Resources, Inc. companies. Please visit Decision Resources, Inc. at www.DecisionResourcesInc.com.

All company, brand or product names contained in this document may be trademarks or registered trademarks of their respective holders.

    For more information, contact:

    Lisa Osgood                            Elizabeth Marshall
    HealthLeaders-InterStudy               Decision Resources, Inc.
    781-296-2606                           781-296-2563
    losgood@hl-isy.com                     emarshall@dresources.com


'/>"/>
SOURCE HealthLeaders-InterStudy
Copyright©2009 PR Newswire.
All rights reserved

Related medicine news :

1. FDA Clears MDN-CGS(R) Intravenous Insulin Dosing Software
2. BioCryst Reports Positive Results From a Phase 2 Study of Intravenous Peramivir for Outpatient Influenza
3. Most Important Factors Driving Usage of Antibiotics in the ICU Setting are Availability in Intravenous Formulation, Activity Against Key Gram Negative Pathogens, Drug Interactions and Bactericidal Activity
4. New form of intravenous iron treats anemia in chronic kidney disease patients on dialysis
5. Number of cardiovascular risk factors could determine safety of intravenous gammaglobulin treatment
6. New Bill Offers Medicare Reimbursement Fix for Intravenous Immune Globulin
7. Availability in Both Intravenous and Oral Formulation is a Leading Drug Attribute Surveyed Physicians Prefer for the Treatment of Urinary Tract Infections in the Hospital Setting
8. Penn study finds pro-death proteins required to regulate healthy immune function
9. Immune deficiency linked to a type of eye cancer
10. Tumors use enzyme to recruit regulatory T-cells and suppress immune response
11. Melanoma drug revs immune cells but cancer cells ignore it
Post Your Comments:
*Name:
*Comment:
*Email:
(Date:6/24/2016)... ... 2016 , ... To succeed under value-based payments, healthcare providers ... how to move forward, given the need to sustain current operations. PYA has ... an organization’s specific needs. , PYA Principal Martie Ross states, “Healthcare providers want ...
(Date:6/24/2016)... Brooklyn, New York (PRWEB) , ... June 24, 2016 , ... ... medical marijuana patients optimize the ingestion of their medication by matching users with high ... allows users to compare pieces with no commitment. , Inhale was founded by two ...
(Date:6/24/2016)... ... ... Dr. Seema Daulat, a native Texan and University of Texas at Austin ... July 13, 2016. , Dr. Daulat earned her Doctorate of Medicine (MD) at The ... the Agape Clinic serving Dallas’ underprivileged community. , Following medical school, Dr. Daulat completed ...
(Date:6/23/2016)... Los Angeles, CA (PRWEB) , ... June 23, 2016 , ... ... being conducted that may expose a possible link between head and neck cancer in ... individuals participating in the study were evaluated based on whether they had gum disease, ...
(Date:6/23/2016)... ... ... The Mechille Wilson Agency, a Texas-based insurance company that provides coverage to hundreds ... a charity drive to assist a student to be chosen from the local area. ... be presented to the chosen student to help with the growing costs of tuition, ...
Breaking Medicine News(10 mins):
(Date:6/23/2016)... 23, 2016 Bracket , a leading clinical ... generation clinical outcomes platform, Bracket eCOA (SM) 6.0, at ... 26 – 30, 2016 in Philadelphia , ... Outcome Assessment product of its kind to fully integrate with ... Bracket eCOA 6.0 is a flexible platform for electronic clinical ...
(Date:6/23/2016)... and INDIANAPOLIS , June ... receiving a Lilly Diabetes Tomorrow,s Leaders Scholarship is any ... scholarship winners, announced today online at www.diabetesscholars.org ... type 1 diabetes stand in the way of academic ... supported the Foundation,s scholarship program since 2012, and continues ...
(Date:6/23/2016)... 2016 Revolutionary technology includes multi-speaker ... , industry leaders in advanced audiology and hearing aid ... Opn ™, the world,s first internet connected hearing aid ... devices.      (Photo: http://photos.prnewswire.com/prnh/20160622/382240 ) ... of ,world firsts,: , TwinLink™ - the ...
Breaking Medicine Technology: