A specialty injectable is a drug therapy designed for treating chronic or life-threatening diseases or conditions requiring administration by infusion, inhalation or injection. The increasing prevalence of cancer and other complex disease conditions is driving the need for specialty injectables.
MCOs are
looking for innovative ways to integrate specialty injectable products into
their benefit designs while maintaining control of cost and utilization. The
latest developments in management of specialty injectable products include new
distribution and reimbursement methods. While some MCOs have successfully
managed specialty injectable programs, most are still in the planning stages.
They should be prepared to spend more time and money managing these specialty
drugs. That said, the benefits of this strategy are considerable and can be highly
beneficial to the health system.
MCOs are
increasingly turning to SPs for their specialty injectable needs. They believe
that SPs have more expertise in administering injectable products. They also
prefer to deal with a company that offers extra services and competitive
pricing. Moreover, many MCOs are mandated to purchase specialty injectable
products through contracted providers. The reason for this type of
participation varies by MCO, however, it is a significant consideration for
MCOs.
This report provides an in-depth analysis of the global specialty
injectable market, market size
As the
costs of specialty injectable drugs rise, health care payers increasingly
contract with specialty pharmacies to provide them. Rather than delivering
these high-cost medications in person, patients often request that they be
delivered to the clinic. This trend, called "brown-bagging," is
impacting many aspects of health care delivery.
Regulatory
approvals for specialty drugs vary widely. While FDA approval of specialty
drugs is mandatory, it is not yet clear how much of the cost is passed along to
patients. The problem arises when the FDA doesn't approve them, and the manufacturer
doesn't accept them as a legitimate prescription. While a specialty drug is
more expensive than generics, it can be negotiated through a plan's formulary.
As a result, some plans are removing specialty injectable from practices while
encouraging their use in other settings. In October 2021, the U.S. Food and
Drug Administration granted approval to the Boehringer Ingelheim for its
Cyltezo (adalimumab-adbm) as the first interchangeable biosimilar with Humira (adalimumab).