Specialty medications continue to be a growing cost in pharmacy benefits, nearing 50% of total drug spend even though only 1% to 2% of Americans use these revolutionary medications., Even more costs can be incurred from health complications if these complex medications are not taken properly or if side effects or a patient’s perceived lack of progress result in premature discontinuation of the therapy. Plan sponsors are looking for ways to ensure specialty patients receive the best results from their medication, while maintaining costs.
EnvisionRx has developed a comprehensive specialty care model that provides a thoughtful approach, unique to each specialty condition that carefully considers clinical effectiveness, member experience and economic impact. To achieve optimal outcomes, we provide condition-focused controls and meaningful data with insights into potential risks, care gaps and cost-saving opportunities. We are truly integrated with our specialty pharmacy, sharing an adjudication platform so that clinicians have access to a patient’s full profile and can provide individualized care throughout treatment. This has allowed us to deliver better results for specialty patients as demonstrated in our recently released 2019 Specialty Rx Key Performance Indicators (KPI) report that collected data from thousands of patient surveys during a rolling 12-month period.
The Service Specialty Patients Need
Due to the complex nature of specialty medications and the diseases they treat, specialty patients may have questions and concerns about their therapy. It is important to offer individualized care that starts before the drug is even dispensed, with monitoring and engagement throughout treatment in order to achieve optimal results. Our high-touch approach that starts with an assessment prior to treatment and offers continual monitoring and counseling has led to clear patient satisfaction according to our KPI report:
High Impact on the Highest Cost Conditions
Inflammatory conditions, such as rheumatoid arthritis, plaque psoriasis and ulcerative colitis, make up almost 50% of all specialty pharmacy prescriptions. Specialty medications used to treat inflammatory conditions cost an average of $5,000 for a 30-day supply and can sometimes reach more than $10,000 per month. In addition to the high cost, adherence to inflammatory treatments can be difficult, whether due to side effects, injection fatigue or simply forgetting. And a lack of adherence can waste the expensive medication or lead to costly health complications.
Our care team spends an average of 18 minutes with inflammatory patients prior to therapy, educating them about treatment expectations, providing proper injection techniques and evaluating disease activity to help start the patient off right and keep them on track. Our KPI report demonstrates the powerful results this individualized care has provided:
Download the full report to see the high-quality results we’re achieving for other specialty conditions and to see actual patient success stories.
 Rosenthal, Marie (2019).Cancer, Orphan Drugs Top 2019 Rx Pipeline. Specialty Pharmacy Continuum. February 15, 2019.
 2018 Trends in Specialty Drug Benefits, PBMI.
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 Li P, Blum M, Feldt J, Hennessy S, Doshi J. Adherence, Discontinuation, and Switching of Biologic Therapies in Medicaid Enrollees with Rheumatoid Arthritis. International Society for Pharmacoeconomics and Outcomes Research (ISPOR). 2010; 1098-3015/10/805 805–812
 Walsh J, Adejoro O, Chastek B, Chun G, Palmer J. Patterns of Treatment Adherence, Persistence, and Discontinuation of Biologic Therapy Among Patients with Psoriatic Arthritis in the United States—Descriptive Analyses from an Administrative Claims Database. Journal of Managed Care & Specialty Pharmacy. March 2017; Vol. 23, No.3-a: S87