Preferred Product Programs for Specialty Drugs
Management Strategies – Why Have Them? 1, 2, 3, 4
A record 45 new specialty drugs were approved in 2015. Historically, there has been an average of 28 new specialty drug approvals per year from 2006-2014. Out of the 45 new drugs approved in 2015, roughly 35% were identified as an innovative product, or the first drug of their class.
Not all new products to market are considered innovative, however. Many are similar in safety and efficacy to drug products already on the market and within the same therapeutic class. With the increase presence of specialty drugs and trend associated with them, MedTrakRx has worked diligently to provide cost-management strategies that will ensure the most cost-effective therapies are available to the right patients at the right time. In order to provide a cost-effective specialty drug benefit, MedTrakRx has implemented several of these cost management strategies within its Best In Class Specialty Rx Program, from step-therapy to prior authorization to tiered formularies.
While step-therapy programs steer consumers toward lower-costing generics within a therapeutic class, preferred product programs shift utilization from non-preferred brands to preferred branded agents within that same therapeutic category. Many therapeutic categories contain products that are highly similar in active ingredient, efficacy, and tolerability. Some of these “me-too” products cost more yet provide no additional health benefit than lower-costing options within the same drug class. Examples of therapeutic classes where MedTrakRx has implemented a preferred product program (also abbreviated PPP) are growth hormone, hepatitis C, inflammatory conditions, multiple sclerosis, prostate cancer, and viscosupplements. (Table 1)
|Therapeutic Category||Preferred Products||Targeted (Non-Preferred) Products|
|Growth Hormone||Norditropin||Genotropin, Humatrope, Omnitrope, Nutropin/AQ, Tev-Tropin|
|Hepatitis C||Harvoni, Sovaldi||Daklinza, Olysio, Technivie, Viekira Pak|
|Inflammatory Conditions||Humira, Enbrel, Simponi 100mg, Stelara||Actemra, Cimzia, Kineret, Orencia, Otezla, Remicade, Rituxan, Simponi 50mg/Aria, Xeljanz|
|Multiple Sclerosis||Avonex, Betaseron, Copaxone, Plegridy|
|Viscosupplements||Euflexxa, Monovisc, Orthrovisc||Gel-One, Genvisc 805, Hyalgan, Supartz/FX, Synvisc/One|
Preferred Product Program (PPP) – How it works
The PPP is an effect cost-saving program that recommends a “switch” or “conversion” from one branded product to another branded product within the same therapeutic category that is equally effective, but less expensive to the plan. It is important to note that MedTrakRx’s Clinical Care Center is very selective in choosing therapeutic categories for the PPP program. In addition, for each drug that is considered non-preferred, there are always equivalent, lower-costing options available for the prescriber to select.
MedTrakRx’s Clinical Care Center applies its clinical expertise to the PPP, requiring preferred products only when clinically appropriate. For example, MedTrakRx does not require a therapeutic “switch” within the inflammatory conditions, multiple sclerosis, and hepatitis C categories when a patient is already stable on therapy. The reason for this is to prevent the potential for therapeutic failure that a patient could experience by switching prematurely to a different drug within that class. Only patients newly-prescribed to a therapy from one of these categories are recommended to a preferred product. For viscosupplements and growth hormone products, the active ingredients in each category are almost identical from product to product. Therefore, these patients are switched over to the preferred product following a one-time override of the non-preferred product.
Contact your MedTrak Account Manager to discuss your Plan’s specific statistics and cost management strategies.
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