CarelonRx: Healthcare leaders can improve community health by adopting a patient-first mindset in specialty pharmacy

The use of specialty medications is on the rise, and we don't see that trend slowing.

As healthcare leaders, we can better the health of our communities and further support patients who rely on specialty medications by adopting a patient-first mindset in our daily roles.

We know specialty medications, which treat complex illnesses, account for 55 percent of total drug spending in the United States, according to IQVIA's recent report, "The Use of Medicines in the U.S. 2022." That's up 28 percent from a decade ago.

We're seeing great advancements in drug discovery and development of specialty medications to treat complex conditions such as autoimmune diseases and cancer, and we continue to see progression of biosimilars (drugs that are very similar to a brand name original drug) to help keep affordable specialty medication options available. Specialty medications are also expanding to cover a range of disease states, including oncology, autoimmune, dermatology, and rare diseases, among others.

It’s a rapidly changing landscape and our most vulnerable patients, those living with complex illnesses and navigating specialty medications, need our steadfast support as healthcare leaders.

We understand this need well as both the president of specialty pharmacy and president of CarelonRx, Elevance Health's pharmacy benefit manager. This year, Elevance Health acquired BioPlus Specialty Pharmacy and advanced construction on three new distribution facilities and four clinical consultation facilities that will support specialty medications for our members.

But making changes to address the evolving needs of patients with complex medical conditions doesn't always need to be drastic. As leaders in healthcare, we can take actionable steps daily toward improving healthcare for our members and patients who rely on specialty medications and ultimately contribute to community health.

This begins by having a patient-first mindset. At the end of the day, this is why many of us got into healthcare. We are helping someone’s mom, dad, brother, sister, friend, overcome some of the most challenging days of their lives, whether that be through identifying best treatment options, providing greater access to therapies, helping to keep therapy costs low, ensuring coverage of medications, or directly administering treatments. As you start your day, make every decision intentionally and with a patient in mind.

Here are three ways healthcare leaders can support individuals relying on specialty medications and better community health:

  1. Drive affordability. Patients and members diagnosed with complex medical conditions should be focused on their health journey, not figuring out how they are going to afford their treatments. Each decision we make as leaders in healthcare should work toward lowering costs for patients and members. For some, that may be educating patients on the cost of their therapy options so they can make an informed treatment decision. For others, this may involve negotiating prices, or working in the lab to inch toward creating another biosimilar option.

  2. Increase accessibility to your experts. Patients’ questions aren’t limited to work hours. When you’re battling a complex disease, your life-dependent question can come at midnight. Commit to having a physician or pharmacist available to patients and members 24/7 if possible. An expert answer at that moment can further medication adherence, prevent adverse reactions and promote patient safety.

  3. Collaborate within healthcare. Patients with complex illnesses often need the guidance and support of each of us simultaneously — healthcare providers, payers, researchers and manufacturers — all working together to promote patient care and advance healthcare.

As leaders in healthcare, we have the unique responsibility to make positive, lasting change together that will benefit patients of today and future generations to come. We encourage each of you to join us in purposefully engaging in these actions daily, for the betterment of those who need us most.

Paul Marchetti is president of CarelonRx and Dan Mandoli is president of specialty pharmacy at CarelonRx.


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