Xavier University FDA Conference: Insurance perspective

Specialty drugs represent improved patient health and profit for manufacturers, but create an insurance conundrum.

A successful patient outcome relies in no small part on packaging reliably delivering medications where needed, making the meds easy to use, and providing clear and concise instruction booklets and all-inclusive kits, particularly for at-home use, seen as a positive trend in that it offers some balance to the higher cost of specialty drugs (see "8 parameters of specialty drugs below) while reducing and/or shortening hospital stays.

A takeaway from Xavier University’s PharmaLink conference was that insurance is a for-profit business, but delivering the best outcome for the patient is the goal, said Humana’s Fran Gregory. The challenge is arriving at this best outcome at the lowest cost.

Gregory said Humana is focusing on the evolving “retailization” of healthcare, and exploring both the opportunities and the challenges.

As recently as 10 years ago the vast majority of Americans were insured by their employer. By 2017, depending on the strength of the economy, up to 44% of us will be accessing healthcare on an individual level.

Insurance likes a great drug that does the job. Humana wants to keep covering those drugs. And certainly no drug maker wants to make a drug no insurance company is willing to cover.

The old model is a patient-disconnected, accessing healthcare on an episodic basis. Today’s consumers are plugged in and proactive, seeking wellness. 

When shopping for coverage, you might assume choices like “that Doctor is in my network, or my hospital is covered” would steer purchase decisions. But actually, “Is my medication covered?” is the primary deciding question that factors into the choice.

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