Managed Care


Specialty pharmaceuticals increasingly administered in costly outpatient clinics

MANAGED CARE June 2012. © MediMedia USA
The Formulary Files

Specialty pharmaceuticals increasingly administered in costly outpatient clinics

MANAGED CARE June 2012. ©MediMedia USA

The mantra “location, location, location” is getting a lot of play, both in real estate and in the specialty pharmacy arena, according to the 2011 Express Scripts Drug Trend Report.

That’s because the PBM’s effort for its members to receive specialty medication in the most cost-effective environments — patient homes and physician offices — demonstrates that there are external factors pushing the national trend in the wrong direction.

The report analyzed MarketScan data to find a gradual decrease in the use of patients’ homes and physician offices — both lower-cost settings. Not coincidentally, if patients aren’t receiving these expensive drugs in physicians’ offices or at home, they’re receiving them in the emergency department or as outpatients in a medical care facility. Use of outpatient facilities grew from 15 percent of medical drug spend in 2006 to 29 percent in 2010. The public might assume that specialty pharmaceuticals are administered in hospitals, but combined use of emergency departments and inpatient facilities accounts for less than 18 percent of the total covered expenditure under medical benefits in 2010.

The report says these drugs are much more likely to be administered in outpatient facilities. In fact, the percentage of medically billed specialty drugs administered in outpatient departments doubled in five years.

Where are specialty drugs administered?

Percentage of specialty drugs delivered in outpatient clinic (for drugs billed through medical benefit.)

Source for both charts: Express Scripts 2011 Drug Trend Report


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