Healthy Skepticism Library item: 7828

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Publication type: Journal Article

Lima HA.
Reimbursement issues for biotherapies: trends and future issues
ASHP Midyear Clinical Meeting 2001 Dec; 36:

Abstract:

Biotech-derived drugs have revolutionized the treatment of a number of medical disorders, including cancer, cystic fibrosis, growth hormone deficiencies, hemophilia, hepatitis, and rheumatoid arthritis, to name a few. Biotherapies are having a financial impact on the U.S. health care system as well. Biotech products have added approximately $13 billion to the prescription drug market, representing 11% of total market share. More than 140 pharmaceutical and biotechnology companies have some 300 biotech products in the clinical trials process. Given the high cost of these biotech therapies, pharmacy providers must position themselves to successfully meet the challenges of providing these costly injectable products to patients. An overview of current and future reimbursement trends for biotech drugs shall be presented. Learning objectives: 1. Describe the role of the prior authorization process relative to the reimbursement of biotech injectable drugs. 2. Understand the use of payer specific treatment protocols (guidelines) to expedite the prior authorization/reimbursement process. 3. List specific chronic conditions and biotech medications. Self-assessment questions: True or False: 1. Hemophilia is a chronic condition treated with biotech derived injectable medications. 2. The explosion in the biotech drug industry has created a new pharmacy practice setting, referred to as specialty pharmacy. 3. The annual cost of biotech therapies for chronic conditions can range from $12,000 to over $100,000. Answers: 1. T; 2. T; 3. T.