Biotech injectable drugs: clinical applications and financial effects

Previously, the authors explored the issues that biotech injectable medications raise for manufacturers and payers (see Biotechnology Healthcare, July/August 2004). This month, the authors focus on actuarial models that provide options analyses and decision-making support when instituting changes in plan design.Employers, insurers, and MCOs must consider innovative plan designs to address the concerns biologics raise. In considering implementation of changes in plan design, stakeholders must, at a minimum, understand the implications relative to costs, reimbursement, and utilization. By modeling specific changes in plan design and detailing the effects on stakeholders, each stakeholder can identify plan design(s) that will optimize clinical outcomes and financial performance.