Physician administered drugs are, by far, the fastest-growing category of health care spending. MDX Hawai’i Responds.

According to a CMS Actuary resource, physician-administered drugs are projected to grow by 60% in the next five years, outpacing all other spend categories by a large margin.

The trend is magnified by the rapid consolidation of Oncology – through health system acquisition and private equity firms. The high-cost Specialty medication pipeline continues to expand and also contributes to this trend. Many drugs currently in development, or recently FDA-approved, are targeted for a small population and subspecialties.  For example, the yearly cost for Tepezza, a treatment approved early this year for Graves’ eye disease, is projected at $375,000 per patient. The prevalence of Graves’ eye disease in only 9 per 100,000.

As such, focusing on specialty drug management is an area of high priority for the agilon health team across the Enterprise, including in Hawaii. In 2019, MDX implemented a partnership with a specialty pharmacy to complement their in-house pharmacist resources.

The MDX Part B drug management initiatives include:

  • The opening of a California-based-specialty pharmacy on Oahu as Hawaii Specialty Pharmacy and they also built an infusion center in Honolulu.
  • Revised workflow for prior authorizations, through input from Hawaii Specialty Pharmacy and the physician offices using the services.
  • A pilot program with Hawaii Cancer Care, a private oncology practice.

Fast forward to today, a year later, the successful collaboration with Hawaii Cancer Care and Hawaii Specialty Pharmacy has driven significant savings; about $1.4million to-date. Christy Agena, Director of Clinical Pharmacy who was responsible for implementing the initiative says “ I am proud of the savings and patient and provider satisfaction this program continues to achieve.  I am excited that we have an opportunity to bring the services to more members and network providers as we expand.”

Additionally, the patient assistance programs by Hawaii Specialty Pharmacy significantly reduced patient out of pocket expenses, often to $0. In fact, two-thirds of members served by Hawaii Specialty Pharmacy have received financial assistance which covers 100% of the patient’s co-pay for the medications.