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Appropriate specialty drug utilization to reduce waste still a top priority.

Payers are still concerned about the inappropriate utilization of specialty drugs, and they see waste reduction as specialty pharmacy’s most valued service, according to The Zitter Group’s Fall 2010 Managed Care Biologics and Injectables Index. 
 
The quantitative web-based survey investigated payer attitudes in 74 specialty products in 14 disease categories. Among the key findings in the index: 
 
Payers expect to see biosimilars in the rheumatoid arthritis and erythropoietin stimulating agent categories within the next 3 to 4 years, and they expect these developments to have a substantial impact on market pricing and utilization. In fact, as biosimilars enter the market, payers — perhaps unrealistically — expect to see at least a 22 percent discount. 
 
Payers also say they will begin to give more attention to orphan disease management. 
 
“Payers have taken all the easy steps to manage specialty costs, and now are tackling the tougher challenges,” says Mark Zitter, CEO, The Zitter Group. 
 
“They are working the demand side via increased cost sharing and the supply side through more aggressive use of prior authorization.” 
 
Average-sales-price–based reimbursement is now predominant in just over 60 percent of plans and increasingly outside the oncology category. Market-share and volume-based contracts remain the most popular forms of specialty drug contracting. 
 
 
 
 
 
 
 
Source: “The Managed Care Biologics and Injectables Index: Fall 2010,” The Zitter Group