Injectable biologic case studies.

Objective: To identify strategies used by a commercial managed care organization (MCO) to affect appropriate cost-effective use and prioritize payment for biologic agents.

Summary: With the rapid increase in the number of biologic agents and the lack of head-to-head comparative trials, determining clinical superiority of one agent may be challenging. Four case studies are presented that highlight strategies used by a commercial MCO to manage the costs and utilization of these agents and identify a preferred biologic therapy to recommend for its internally developed prior-authorization (PA) criteria for rheumatoid arthritis, asthma, psoriasis, and multiple sclerosis.

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.