Biologics and Benefit Design: What's New For '06?

Abstract

With an anticipated spate of new products still on the horizon and the need to focus now on Medicare's new drug benefit, health plans and employers are more likely to tweak than overhaul biologics coverage in 2006. Key trends include higher cost sharing with employees and a continued effort to move biotech drugs from the medical to the pharmacy benefit.

“Specialty drugs will begin to end as a separate category,” says Bradford L. Kirkman-Liff, DrPH, of Arizona State University’s W. P. Carey School of Business. “More drugs will be excluded by health plans as tiering changes, and all patients — including oncology patients — will have to pay more of their drug costs.” PHOTOGRAPH BY DAVID SCHMIDT

COMING: HIGHER OUT-OF-POCKET COSTS, SEPARATE SPECIALTY PHARMACY BENEFIT A Zitter Group survey of key managed care decision makers, examining current and anticipated strategies for managing specialty pharmaceuticals, found that moving all specialty products into the drug benefit remains unlikely — regardless of how costs are shared. Anticipated management strategies for specialty drugs* *106 respondents. All percentages are rounded to the nearest whole number. SOURCE: MANAGED CARE INJECTABLES INDEX, SPRING 2005, THE ZITTER GROUP, SAN FRANCISCO

Thomas Baker