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An overview of specialty drugs & their impact on your pharmacy-benefit plan
Specialty drugs are high-cost prescription medications typically used to treat chronic conditions. Most often, they require specialty handling and administration by the dispensing pharmacy and prescribing physician. At a glanceComplex Large Molecules and Biologic Drugs Biology-based molecules that structurally mimic compounds found within the body. High Cost per Prescription Average cost of $3,000 per month. […]
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Specialty drugs are high-cost prescription medications typically used to treat chronic conditions. Most often, they require specialty handling and administration by the dispensing pharmacy and prescribing physician.
At a glance
Complex Large Molecules and Biologic Drugs
Special Handling and Distribution
Multiple Dosage Forms
Trends
The specialty-drugs market has experienced robust growth within the last five years, predominantly driven by average wholesale price inflation, increases in utilization / intensity, and new drugs entering the market. These factors have contributed to what today is estimated to be a 20 percent price increase for 2016, 2017, and 2018. What’s most startling is that while specialty drugs account for less than 1 percent of drugs dispensed for most employer groups, the corresponding spending makes up 25 percent of total costs, on average.
It is expected that specialty drugs will account for 40 percent of total drug spending by 2018. Furthermore, 40 percent to 50 percent of drugs in late-stage FDA approval are specialty drugs, representing potentially 200 new drugs in the next couple years. Thus, there is not a lot of relief on the horizon for employers and their benefit plans.
The role of the pharmacy benefit manager
Prior Authorizations — A strong pharmacy benefit manager (PBM) partner first helps clients manage the costs associated with specialty medications through a prior-authorization process. A robust prior-authorization process is intended to be used as a tool to ensure the medication is appropriate for the diagnosis. Along with requiring documentation demonstrating medical necessity, case reviews should also be done to be sure other options, where appropriate, have been tried. In some cases during the prior-authorization process, reviewers will identify an opportunity where possibly an alternative medication should be considered. Your PBM should then work with the physician to discuss the option(s) to see if they are appropriate for the patient.
Clinical Review / Intervention — In some instances, medications will be prescribed for conditions or at dosages outside of what is currently FDA-approved. Unless substantiated by convincing and proven medical and/or clinical data, these medications are considered experimental in nature in the treatment of the particular diagnosis and will be denied. In these cases, your PBM should conduct an in-depth review of the medication and evidence available before deciding whether the medication will be approved or denied. If the medication is in fact denied, a written letter explaining the denial is sent to both the physician and plan member. This letter should also outline the process of appealing the decision should the physician decide to do so. This extension of the prior-authorization process ensures that the right medication and dosage is selected for each patient.
The role of the dispensing specialty pharmacy
Clinical management — Your partnering specialty pharmacy should provide clinical-management programs that are designed to increase compliance and adherence to therapy. The clinical staff should have extensive training regarding the monitoring of side effects and manufacturer policies for each specialty medication that is dispensed. The goal of these programs is to educate patients on the medications they are taking, prevent adverse effects, identify potential side-effects, and promote overall health and wellness.
Comprehensive programs — Comprehensive programs should start with a basic assessment of each patient. From there, additional educational materials are identified that may help support a patient’s adherence to their medication regimen. At the same time, a patient can be scheduled for a follow-up assessment by a registered pharmacist or registered nurse. These follow-up assessments often take place at the time of coordination for delivery of the patient’s next refill, and they can also occur at an appropriate frequency based on the needs of the patient and/or the plan.
Robust fulfillment & delivery — The ideal specialty pharmacy will provide a full benefit and co-pay assistance investigation with every script that is filled. Value-adds include: free ancillary supplies such as sharps containers, syringes, alcohol swabs, and bandages. Due to the complexities of some specialty drugs, your specialty pharmacy should ship packages for next-day delivery to your home, physician’s office, or place of work.
Erison Rodriguez is the regional sales and marketing director for ProAct, Inc. — a pharmacy-benefit management company headquartered in DeWitt. It is a division of KPH Healthcare Services, Inc., which also operates Kinney Drugs. Contact Rodriguez at ErisonRodriguez@ProActRx.com
Ithaca Tompkins Regional Airport converting to jets
ITHACA — Beginning in 2017, the Ithaca Tompkins Regional Airport says it will begin incorporating Embraer 145 jets as part of a deal with American Airlines. The 50-seat jets will replace the existing turboprop planes to accommodate increased traffic to Ithaca, the airport said in a news release issued on Oct. 28. The change from
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ITHACA — Beginning in 2017, the Ithaca Tompkins Regional Airport says it will begin incorporating Embraer 145 jets as part of a deal with American Airlines. The 50-seat jets will replace the existing turboprop planes to accommodate increased traffic to Ithaca, the airport said in a news release issued on Oct. 28.
The change from turboprop planes to jets comes after American Airlines recently decided to consolidate its flights to Philadelphia, ending its services to the Greater Binghamton Airport and Elmira Corning Regional Airport early next year.
Ithaca Tompkins Regional Airport says it will become the official Southern Tier hub for flights to Philadelphia with American Airlines, Newark with United Airlines, and Detroit with Delta Air Lines.
“Ithaca’s a destination,” airport manager Mike Hall contended in an interview with Spectrum News, which the news release cited. “A lot of people want to come here… most of our travel is business travel.”
Airport officials say that with the increase in traffic, comes the opportunity for improving facilities and equipment. Ithaca Tompkins Regional Airport is “still hopeful” to receive funding from an upstate airport redesign competition for the improvement of security services, building a screening room, and including customs services within the airport.
Beginning in 2017, Ithaca Tompkins Regional Airport hopes to “clear at least 100 aircraft within their first year of business.” The airport expects to add regional jet service to Newark via United Airlines later in 2017.
The Ithaca Tompkins Regional Airport contends that it generates nearly $70 million in annual positive economic impact on the area, which supports 510 jobs. The airport is a “gateway” for travelers to Cornell University, Ithaca College, and Tompkins Cortland Community College.
In June of this year, the Tompkins County Legislature authorized the county to accept a nearly $350,000 grant from the New York State Department of Transportation (DOT) to help fund marketing and promotion at Ithaca Tompkins Regional Airport.
The grant — under the DOT’s Statewide Opportunities for Airport Revitalization (or SOARs) program — is being used to offset the cost of marketing and associated consulting fees to help improve and increase service at the airport, according to the legislature. Hall, the airport manager, noted at the time that acceptance of the grant would allow the airport to boost its promotion and marketing as it tries to attract more flights, without increasing the facility’s operating budget for marketing.
Contact Rombel at arombel@cnybj.com
Clean Energy Standard Establishes Good Public Policy and Saves Thousands of Jobs
The New York Public Service Commission’s newly adopted Clean Energy Standard is a smart solution to a complex problem. It institutes a good public policy that will provide economic and environmental benefits to all New Yorkers for years to come. Not only is this helping our local James A. FitzPatrick Nuclear Power Plant to remain
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The New York Public Service Commission’s newly adopted Clean Energy Standard is a smart solution to a complex problem. It institutes a good public policy that will provide economic and environmental benefits to all New Yorkers for years to come. Not only is this helping our local James A. FitzPatrick Nuclear Power Plant to remain open, but it is also helping all upstate New York nuclear plants to remain operational. This will keep thousands of jobs in the state, and carbon-free electric generation in New York.
Since the Public Service Commission (PSC) adopted the new Clean Energy Standard, there have been many critics who say nuclear power should not be eligible for subsidies. The criticism from so-called environmentalists is baffling because nuclear power is clean and generates zero carbon emissions, 24/7. Currently, according to the New York Independent System Operator’s most recent data, 4.53 percent of the state’s electricity needs are met with wind and solar sources, 17 percent are met with hydro, and 30 percent with nuclear generation. Without nuclear power, New York would lose an essential source of carbon-free generation. It would likely be replaced by imported power generated from fossil fuels — something that the environmentalist groups vehemently oppose.
There are many reasons why the PSC’s forward-thinking policy is good for the state. Without the Clean Energy Standard, Upstate would lose thousands of jobs, businesses and homeowners would face steeper electricity prices, and our state would lose fuel diversity. If the PSC had not included nuclear power in the Clean Energy Standard, it is likely that all four nuclear-power plants in upstate New York would close — never to reopen. This would be economically disastrous for upstate New York.
For our community, this policy is a win-win. It not only ensures carbon-free generated electricity, but also helps ensure the health of our upstate economy. The four nuclear-power plants — the FitzPatrick Nuclear Power Plant, Nine Mile Point I and II, and R. E. Ginna Nuclear Power Plant — add $3.16 billion to the state’s gross domestic product. They account for nearly 25,000 direct and indirect full-time jobs and contribute $150 million in net state tax revenues annually.
According to the Brattle Group, the plants also reduce energy costs by $1.7 billion per year. This is because nuclear power produces power consistently and reliably, which helps stabilize the energy market. Indeed, in New England states, consumers are experiencing increased energy costs due the closure of Vermont Yankee Nuclear Power Plant. With its closure, the New England market has less fuel diversity, leaving electricity prices closely tied to the cost of natural gas. This was evident this summer as New England’s electricity prices jumped 38 percent (from June to July) mainly because the cost of natural gas increased by 43 percent. With the impending closure of another nuclear-power plant in the New England region, one can expect that costs will continue to go up for consumers in these states.
Last year, our area was devastated when Entergy announced that it would shutter FitzPatrick. Fortunately, many in the community rallied around the plant and a solution was found to what would have otherwise been a catastrophic outcome for the entire region. Other plants would surely have followed the same fate had the PSC not adopted the Clean Energy Standard. We should embrace this policy and applaud this forward-thinking solution.
William (Will) A. Barclay is the Republican representative of the 120th New York Assembly District, which encompasses most of Oswego County, including the cities of Oswego and Fulton, as well as the town of Lysander in Onondaga County and town of Ellisburg in Jefferson County. Contact him at barclaw@assembly.state.ny.us, or (315) 598-5185.
The latest progress report from START-UP NY shows it’s losing participants almost as quickly as it’s adding them. In an Oct. 28 press release, Governor Cuomo reported: “START-UP NY now has commitments from 202 companies to create at least 4,490 new jobs and invest more than $251 million over the next three-to-five years throughout New
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The latest progress report from START-UP NY shows it’s losing participants almost as quickly as it’s adding them.
In an Oct. 28 press release, Governor Cuomo reported: “START-UP NY now has commitments from 202 companies to create at least 4,490 new jobs and invest more than $251 million over the next three-to-five years throughout New York State.”
But that 4,490 job figure is a net increase of only 212 jobs from the 4,278 commitments that were reported in December 2015. Since then, the governor’s office has twice announced additional commitments: 135 jobs in March and 817 jobs in October. So while the program added new commitments to create 952 jobs, its total count of five-year commitments rose by only 212 jobs. That’s because 740 existing commitments were lost. This means that for every four jobs that START-UP added since December, it lost three jobs.
As we explained in July, START-UP appeared to have peaked during 2015, adding about 2,100 five-year job commitments in each of its full years of operation (calendar 2014 and 2015).
Unless the program adds 1,843 new commitments in the next two months — and doesn’t lose any commitments in the meantime — 2016 will be the weakest year for START-UP since its creation.
The drop-offs wouldn’t be so surprising if the program actually was limited to genuine start-ups. Nationwide, nearly one-third of start-up firms failed between 2013 and 2015, according to the U.S. Small Business Administration. New York State has stretched START-UP’s eligibility to include existing companies, but the numbers still aren’t impressive.
Of the 39 companies listed in the October announcement, 16 are existing New York businesses, and seven are existing companies that are “new to New York.” Only 16 companies would fit any definition of true start-ups. The new companies are distributed across the state, with the biggest concentration — eight companies and 213 new jobs — located at University at Buffalo.
As the Empire Center’s E.J. McMahon wrote a year ago, “few economic development initiatives in New York State’s history have been the subject of more marketing hype than START-UP NY.” But a program of tax-free micro-zones on and near college campuses is nowhere near potent enough to overcome New York’s other competitive disadvantages, which the governor has compounded with policies including opposition to natural-gas pipelines, a costly renewable-energy mandate, and the nation’s highest minimum wage.
Ken Girardin is the communications and marketing manager at the Empire Center, overseeing the center’s external communications operations and maintaining its presence on social media. Contact him at kgirardin@empirecenter.org. This article is drawn from Empire Center’s NY Torch blog.
Fust Charles Chambers LLP has promoted the following individuals. MARY ELLEN ROMAGNO has been promoted to audit manager. She joined the firm in 2011 after graduating from Le Moyne College and is a CPA. KATELYN M. ALLEN, KARA CLINE, KATHLEEN M. SIERTNIK, and MEGAN WALTERS have been promoted to tax managers. Allen joined the firm in 2008 after graduating from
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Fust Charles Chambers LLP has promoted the following individuals.
MARY ELLEN ROMAGNO has been promoted to audit manager. She joined the firm in 2011 after graduating from Le Moyne College and is a CPA.
KATELYN M. ALLEN, KARA CLINE, KATHLEEN M. SIERTNIK, and MEGAN WALTERS have been promoted to tax managers. Allen joined the firm in 2008 after graduating from Le Moyne College and is a CPA. Cline, a CPA, also joined the firm in 2008 after graduating from Le Moyne. Sierotnik is a CPA and joined Fust Charles in 2006 after graduating from Le Moyne. Walters, a CPA, joined the firm in 2004 after graduating from SUNY Oswego.
MATTHEW P. BERRIGAN, CPA; RYAN GORMAN; and DANIEL J. VONA, CPA have been promoted to senior audit associates at Fust Charles. Berrigan joined the firm in 2015 and is a graduate of SUNY Oswego; Gorman joined Fust Charles in 2013 and is a graduate of SUNY Oswego; and Vona joined the firm in 2014 and is a graduate of Le Moyne.
Contact The Business Journal News Network at news@cnybj.com
Dermody, Burke & Brown, CPAs, LLC
TINA D’AGATA and THOMAS PALMER, of Dermody, Burke & Brown, CPAs, LLC, have been named senior managers. D’Agata is a senior manager in the employee benefits department. She has been with the firm for 16 years and is a graduate of Hartwick College. Palmer is a senior manager in the audit & accounting department. He has been
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TINA D’AGATA and THOMAS PALMER, of Dermody, Burke & Brown, CPAs, LLC, have been named senior managers. D’Agata is a senior manager in the employee benefits department. She has been with the firm for 16 years and is a graduate of Hartwick College. Palmer is a senior manager in the audit & accounting department. He has been with the firm for 15 years and his experience in accounting includes various external and internal audit engagements for not-for-profit organizations, school districts, and for-profit entities. Palmer a CPA and a graduate of SUNY Geneseo.
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SWBR Architects has hired designers KYLE MORRIS and NICHOLAS DURNIN, JR., based in the firm’s Syracuse office. Architectural designer Morris has more than 10 years of experience in the industry and brings an expertise in building code to SWBR. He earned his bachelor’s degree in architectural-engineering technology from Alfred State College. Durnin joins the firm from Wolfe Architecture, where he
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SWBR Architects has hired designers KYLE MORRIS and NICHOLAS DURNIN, JR., based in the firm’s Syracuse office. Architectural designer Morris has more than 10 years of experience in the industry and brings an expertise in building code to SWBR. He earned his bachelor’s degree in architectural-engineering technology from Alfred State College. Durnin joins the firm from Wolfe Architecture, where he served as project manager and draftsman. He earned his bachelor’s degree in architectural technology from Alfred State College.
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DANIELLE GERHART has been hired as public relations & advocacy manager at Bankers Healthcare Group. Prior to joining BHG, she was a senior content manager at Eric Mower + Associates, where she spent 11 years in PR. Gerhart earned a bachelor’s degree in communications from Appalachian State University. Contact The Business Journal News Network at news@cnybj.com
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DANIELLE GERHART has been hired as public relations & advocacy manager at Bankers Healthcare Group. Prior to joining BHG, she was a senior content manager at Eric Mower + Associates, where she spent 11 years in PR. Gerhart earned a bachelor’s degree in communications from Appalachian State University.
Contact The Business Journal News Network at news@cnybj.com

LeChase Construction Services, LLC has added ART THOMPSON as a senior project manager in its Ithaca office. He has more than 30 years of experience in managing residential, commercial, and higher-education construction projects. Thompson was previously a senior project manager for Gilbane Building Company. He also spent eight years as manager of projects in Cornell University’s construction
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LeChase Construction Services, LLC has added ART THOMPSON as a senior project manager in its Ithaca office. He has more than 30 years of experience in managing residential, commercial, and higher-education construction projects. Thompson was previously a senior project manager for Gilbane Building Company. He also spent eight years as manager of projects in Cornell University’s construction management section, and nine years as a superintendent at Christa Construction in Victor (near Rochester).
Thompson, who attended Cornell University’s Leadership Development Program, started his career working in residential construction.
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The Chazen Companies has hired JOHN O. REVETTE, professional engineer, for its Syracuse office. He brings more than 12 years of experience in municipal treatment plan and conveyance system design. Revette earned his bachelor’s degree from Clarkson University in Potsdam and his master’s degree from John Hopkins University in Baltimore. Contact The Business Journal News Network at news@cnybj.com
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The Chazen Companies has hired JOHN O. REVETTE, professional engineer, for its Syracuse office. He brings more than 12 years of experience in municipal treatment plan and conveyance system design. Revette earned his bachelor’s degree from Clarkson University in Potsdam and his master’s degree from John Hopkins University in Baltimore.
Contact The Business Journal News Network at news@cnybj.com
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