For people with an autoimmune condition, the path to effective treatment rarely follows a straight line.  

A diagnosis can take years, therapies may span pharmacy and medical benefits, and a medication that manages one patient’s symptoms may fall short for another. Meanwhile, specialty drug costs continue to climb, leaving health plans to balance access and affordability without adding friction to an already challenging patient journey. 

In the latest episode of the “Pharmacy Friends” podcast, “Autoimmune care: Seeing the full picture,” join host Maryam Tabatabai, PharmD, associate vice president of clinical information at Prime Therapeutics (Prime), and guests Sneha Sharma, PharmD, director of specialty clinical solutions at Prime, and Timothy O’Shea, PharmD, M.S., director of specialty pharmacy at Horizon Blue Cross Blue Shield of New Jersey, as they discuss how a more connected benefits approach can help improve the management of autoimmune conditions. 

“There’s probably no one category where integration is more important than autoimmune — maybe oncology as well — because you have drugs spanning the pharmacy and medical benefits,” O’Shea said.  

By bringing pharmacy and medical data together, health plans can see a more complete picture of a patient’s care. And the integrated approach makes complex decisions easier to navigate, while improving outcomes and helping to manage cost of care. 

“We need to truly understand where these patients are in their journey,” Sharma said. “That integrated approach allows us to see what they’re filling, catch duplicate therapies and identify opportunities to improve care.” 

As new targeted treatments — such as chimeric antigen receptor T-cell therapies, which modify a patient’s immune cells to recognize and attack disease-causing cells — enter the autoimmune pipeline, integrated data and coordinated clinical approaches will become increasingly important to connecting cost and care and delivering the right therapy in the right setting.  

“At the end of the day, it’s not about just one drug,” Tabatabai said. “It’s about the broader condition and the whole person in terms of management.”  

Listen to the latest episode of the “Pharmacy Friends” podcast   

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