This poster evaluates the financial impact of high-cost infused medications across three site of care programs. Site of care programs help payers save money on specialty drug spend by shifting utilization on high costs infused medications to less costly sites of administration. The objective of this project was to evaluate the costs associated with the administration of select high-cost infused medications in site of care programs in Massachusetts Medicaid populations. Research was done through retrospective analysis that included pharmacy and medical claims data for select high cost infused medications between April 1, 2017 - September 20, 2017. This presentation was given at the 2018 Managed Care & Specialty Pharmacy Annual Meeting and received the AMCP Foundation Best Poster Award in the Resident and Fellows category.

This pilot program was developed in response to a drug utilization review within a large Medicaid population that revealed some hazardous practices. Co-prescribing of opioids with benzodiazepines, gabapentin, and other stimulants occurred in more than 500 members, putting them at risk for additive central nervous system depression, misuse, abuse, and death from overdose. The poster presentation outlines the objectives, methods, and results of a telephonic outreach program that addressed these safety concerns. It captures prescriber awareness of the presence and risks of potentially deadly medication combinations among members in their care, with some intriguing results. Our experts provide health plans with framework and support to address the opioid epidemic head on with robust opioid medication management programs, evidence-based clinical guidelines, and prescriber outreach. Our interdisciplinary team’s innovative approach helps health plans decrease inappropriate opioid usage and while ensuring members maintain access to appropriate pain management. This presentation was given at the American Drug Utilization Review Society (ADURS) conference February 22-24, 2018 in Scottsdale, Arizona.

Statistics show approximately 15 million Americans suffer from NASH, a nonalcoholic fatty liver disease that is projected to become the most common reason for liver transplantation. There are no FDA approved therapies for NASH, so doctors are forced to treat patients with off-label medications while keeping an eye out for breakthroughs in medication development. Two novel therapies, obeticholic acid and elafibranor, are currently in Phase III trials. If they receive FDA approval, interest will be high as they will be the first treatments specifically labeled for NASH. We detail a budget impact model for a sample state Medicaid plan in this poster presentation. This activity is valuable for payers to anticipate the impact of cutting-edge therapies in their population and proactively plan management strategies that ensure member access while maintaining cost-effectiveness. This presentation was given at the American Drug Utilization Review Society (ADURS) conference February 22-24, 2018 in Scottsdale, Arizona.

Pipeline Trends is produced by UMass Medical School’s Clinical Pharmacy Services and is distributed annually. This edition provides a comprehensive overview of: Promising New Agents Projected Generic Entry Investigational Indications FDA Updates Industry Trends

Specialty drug spend increased by 15 percent to $121 billion in 2015 and is projected to rise even more. Budget-conscious payers need to implement novel management strategies that anticipate the cost of specialty medications before they’re available. A summary of efficacy data for high-impact specialty pipeline drugs expected to reach the market, including their place in therapy and budgetary impact. Also featured are strategies to mitigate costs of these cutting-edge medications and compare them to current therapy options.