Unbiased Analysis of Today's Healthcare Issues
A recent paper by Kacerek and Mattingly (2025) aims to answer why certain drugs are defined as “specialty” drugs and others are not. They first cite an Office of the Inspector General (OIG) report: The OIG found that there was no standard definition in Medicaid and that Medicaid programs used more than 100 different characteristics to…
Specialty drugs have delivered significant improvements to patient health, but oftentimes they pay be expensive. To try to insure that these treatments are used appropriately, some health plans impose a utilization management tool known as “prescriber requirements” where only certain types of physicians may prescribe a drug. While this may be useful for some complex…
Increasingly, integrated delivery networks (IDNs) are creating their own full-blown specialty pharmacies. Many are familiar with the integrated payer-provider model from groups such as Kaiser Permanente. However, other IDNs are getting into the game according to a recent white paper. Why are IDNs considering creating their own specialty pharmacies? Address patient access concerns. The number…
That is one trend as reported in Modern Healthcare. Being able to better managed health care spend across medical and pharmacy is one reason. In 2018 alone, about 76% of hospitals with over 600 beds operated a specialty pharmacy, in comparison to a little under half in 2016, according to American Society of Hospital Pharmacists. Growth in…
Specialty drugs are often injectibles, biologic drugs, or other drugs that require specialized administration, handling, or ongoing clinical assessment. Specialty drugs are often more expensive than standard pharmaceuticals. As the use of specialty pharmaceuticals has become more common, a paper by Hill, Miller and Ding (2020) aims to quantify how much spending on specialty pharmaceuticals…
According to Chambers et al. (2019), the answer varies widely depending on the health plan. The authors use a data from the Tufts Medical Center Specialty Drug Evidence and Coverage (SPEC) database. 203 specialty drugs issued by 17 of the 20 largest US commercial health plans are included in the database. This study examines nearly…
The U.S. has a decentralized health care system. This means that depending on your health plan, you may have more or less generous coverage. But how does coverage vary across plans? A recent paper by Chambers et al. (2018) looks specifically at coverage of specialty drugs. Using the Tufts Medical Center’s Specialty Drug Evidence and Coverage…