Anticipating the future: how the emergence of innovative biologic agents impacts benefit design, utilization, and provider relations.

Objective: To review the impact of biologic therapies on commercial and government payers.

Summary: Biologic agents, a mainstay in the treatment of cancer and immunopathologic conditions, are being used for an expanding number of indications, and new agents are being developed for use in many other diseases. These biologic agents have the potential to improve patient quality of life and the overall quality of care with minimal risk of adverse events. Many of these agents require administration via nontraditional methods and are priced at a premium, compared with existing therapies. Consequently, both commercial and government payers must devise strategies that simultaneously ensure access to these agents while minimizing their overall cost impact. Several tools are available to payers to achieve these goals, including aggressive formulary management, drug-use evaluation, and the use of specialty pharmacy services.

Conclusion: With appropriate planning and oversight, the value of biologic therapy can be optimized in the managed care setting.