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Specialty Pharmacy Trends
October 2016
The pharmacy benefit landscape today is complex and rapidly changing. One of the most significant drivers of pharmacy cost increases is the continued introduction of new specialty drugs into the marketplace. Worrisome trends, such as patent exclusivity, lack of high-quality alternatives, and lack of price regulation are making it critical for payers and employers—including large health systems—to better understand their specialty drug spend and find ways to combat the cost without reducing the quality of care.
Consumer-directed health plans are one of the fastest-growing benefit options for U.S. employees. A CDHP is a high-deductible preferred provider organization that is combined with either a health reimbursement arrangement or health savings account. Fund contributions are made by plan members or sponsors annually; unused amounts are typically carried over to the next plan year. Participants are encouraged to use decision-support tools to make more informed healthcare decisions and efficiently manage their fund. Truven Health Analytics conducted a study to provide employer and health plan decision-makers, and others in the healthcare industry, with key insights on the effectiveness of CDHPs in terms of multiyear cost, care, and utilization changes.
The Truven Health Analytics™ 15 Top Health Systems study identifies U.S. health system leadership teams that have most effectively aligned outstanding performance across their organizations, and achieved more reliable outcomes in every member hospital. The study measures relative balanced performance across a range of organizational key performance indicators including care quality, use of evidence-based medicine, postdischarge outcomes, operational efficiency, and patient perception of care. Just as evidence-based medicine is key to exceptional patient care, evidenced-based management is key to the well-being and success of health systems.
The changing healthcare environment has put pressure on healthcare organizations to deliver top-quality care while keeping costs under control. Superior operational and financial performance can be measured by high margins and low costs. But there are significant operational indicators that differ between high- and low-performing hospitals, depending on whether performance is defined by expense or by margin. Often, hospitals with the lowest costs are considered the most successful. But low-cost hospitals do not necessarily behave the same way as hospitals with healthy margins. Low-cost hospitals can include both efficient hospitals and hospitals that are in dire financial circumstances that have forced them to even eliminate expenses necessary for their long-term fiscal health.
