Specialty Medication Seminar

Presenter:

John Ottavi, CPCU, GBA

Vice President

Cottingham & Butler

The program will broadly hit on pharmacy cost containment with a focus on Specialty.    Employers have not implemented many fundamental cost containment strategies including:

1. Step Therapy
2. Mandatory Generic
3. Mandatory Maintenance Mail Order
4. Prior Authorization
5. Excluding Compounds – Prior Authorization on Compound medications
6. Excluding manufacturers coupons – this is tough one for the PBM’s
7. Medical necessity on Specialty RX –
8. There are six defensive walls employers should build around Specialty to protect plans.  Any specialty prescription that wants to be paid from plan resources should pass through six checkpoints:#1:  Should the drug even be covered?#2:  Is the drug appropriate for the member?

   #3:  Has the member been incentivized to use available alternatives?

   #4:  Has the supply of the drug been minimized?

   #5:  Has the cost of the drug been minimized?

   #6:  Have you ensured the member is actually paying their cost sharing?