Addressing Costs and Continuity of Care through Innovative Solutions for Infused Therapies: A Collaborative Experience with Infliximab.

BACKGROUND: Infused therapies are becoming more common as pharmaceutical and biotechnology companies increasingly focus their research and development efforts on biologic agents.
OBJECTIVE: To understand how collaborative efforts among a health plan, providers, and specialty pharmacies can improve the efficiency of delivering infused therapies, using the example of a pilot program in southern Ohio for the administration of infliximab.
METHODS: In October 2008, the authors conducted one-on-one, in-person interviews with representatives of a health plan, a specialty pharmacy, and the 3 largest gastroenterology practices in a southern Ohio community that collaborated to develop an innovative pilot program for delivering infliximab for patients with inflammatory bowel disease in a cost-effective manner in the office setting. The 2 health plan and 1 specialty pharmacy representatives were directly involved with the development and implementation of the program. Gastroenterology practice representatives included 3 practice managers, 2 infusion nurses, 2 billing managers, and 1 precertification specialist.
RESULTS: The interviews revealed the opportunities and challenges associated with managing infused therapies, as well as the potential unintended consequences of unilateral action by health plans. As a result of changes introduced by a local health plan in southern Ohio, 3 of the largest gastroenterology practices in the region decided to discontinue in-office infliximab infusions for their patients and send them to local hospital outpatient infusion centers. However, before the implementation of this policy, a new collaboration between the health plan, the 3 practices, and the health plan's specialty pharmacy enabled these practices to continue to provide this medication in their offices. This collaboration avoided cost increases to all involved by preventing the shift of patients to hospital outpatient departments and allowing patients to continue their care in the office setting.
CONCLUSION: It will become increasingly important for payers to develop and support cost-effective ways to provide physicians and patients with access to infused medications. This pilot program shows the benefits of collaboration among healthcare stakeholders to identify innovative solutions for delivering appropriate office-based infusion therapy. The specific approach that is most appropriate for a specific health plan will depend on the unique local market circumstances.