The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.
Historically, it’s rare for commercial payers to have drug formularies for medical benefits, but that’s changing. In effect, health plans are, in some ways, choosing drugs they prefer, based on their judgments about safety and efficacy, as well as availability, lowest net cost, and how a drug is administered.
The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.
By some measures, the financial and health toll from inflammatory bowel disease, rheumatoid arthritis, and psoriasis is comparable to stroke and lower back pain. Collectively, they affect about 10 million patients in the United States. They are chronic conditions characterized by immune-mediated inflammation of unknown etiology and for which there is no cure.
Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.
This program used team meetings followed by coaching to help initiate best practices for patients with chronic conditions and/or end-of-life care needs. The coaching component ensured that implementation teams received guidance in the planning and adoption process, stayed on track with implementation, and had access to timely support in addressing unanticipated barriers.