Specialty Pharmaceuticals

Specialty Pharmaceuticals

Specialty pharmaceuticals are high-cost drugs used to treat complex, rare, or chronic diseases. Although used by less than two percent of the patient population, specialty pharmaceuticals currently represent approximately 25 percent of overall drug costs and are growing at more than 20 percent per year. Introduction of new specialty drugs, broader applications for a wide variety of illnesses, and increasing demand by an aging population will continue to drive the growth in specialty medications. With nearly 50 percent of all drugs in development being classified as specialty, it's easy to understand why our health plan clients have told us that managing specialty pharmacy costs is among their top two priorities.

Specialty Pharmacy Requires SpecialtyCare

The ProCare SpecialtyCare Program immediately links a clinical pharmacist with each patient requiring specialty medication. The clinical pharmacist consults with the patient regarding the prescribed therapy, side effect management, relevant clinical information, and the importance of adherence and compliance. This personal relationship forms the core of the SpecialtyCare program. Through this key process, we are able to significantly reduce costs to the health plan by monitoring for adverse reactions that could interrupt therapy and cause a costly drug failure. We've also found that this reduces inappropriate utilization as well as the possibility of fraud, waste, and abuse.

Our specialty pharmacy serves the needs of both the patient and the health plan by:

  • Minimizing patient out of pocket expense through appropriate formulary education
  • Managing the authorization process with the health plan
  • Integrating specialty, mail, and retail claims into the ProCare Rx real-time claims processing system
  • Verifying prescription information with the physician to insure appropriate utilization
  • Making personalized scheduled calls to arrange for refills
  • Contacting patients to coordinate delivery times and locations
  • Tracking shipments to ensure on-time delivery

We work closely with our clients to control specialty drug spend while at the same time maintaining the highest possible patient satisfaction. Personal clinical support, a full inventory of oral medications, specialty injectable and infused drugs, and guaranteed drug integrity and quality products - ProCare SpecialtyCare is ready to serve the needs of your diverse member population.