Specialty pharmaceuticals and the quest for better outcomes

Over the past decade, the healthcare system has seen significant growth in the number of products, pathways, and modes of treatment administration for a number of costly conditions. Many of these products are biologic agents, classified as specialty pharmaceuticals, and are distributed through specialty pharmacies. The increasing use of these expensive medications and their growing costs raise the simple question, can payers and purchasers afford to keep doing business as usual? In addition, confusion exists as to what “outcomes” are relevant for these conditions treated using specialty medications. Available information on outcomes, treatments, and pathways from multiple sources can overload clinicians and the treatment team, making it difficult to select – and receive reimbursement for – the most appropriate regimens. This article offers an approach to understanding some of the unique challenges posed in evaluating the value of specialty pharmaceuticals.