There is a growing number of specialty medications with requirements that exceed standard characteristics, newly defined as "ultra-complex." This article details ultra-complex specialty medications, and strategies implemented by VSP to maintain an optimal patient journey. Ultra-complex specialty medications provide unprecedented therapeutic advancements but demand multidisciplinary resources to reach the desired therapeutic goals, which make health systems an ideal management setting.

This primer describes the structure of copay accumulator, copay maximizer, and alternative funding programs used by payers and self-employers to shift costs for high-priced specialty medications. The primer uses a patient case throughout to highlight the unique structure of these programs and their impact on patient affordability and access.

This study presents results from a national survey evaluating barriers, needed support and program goals for implementing long-acting injectable HIV ART. This work was performed under the larger Accelerating Implementation of Multilevel Strategies to Advance Long-Acting Injectable for Underserved Populations (ALAI UP Project).

This quality improvement project implemented the use of tools in the electronic health record that allowed specialty pharmacist to discretely document clinical data for Hepatitis C as part of their normal workflow. Post-implementation, the documentation burden for pharmacists was reduced and documented data was used to create a near real-time dashboard for reporting and tracking patient outcomes.

This study evaluated the out-of-pocket (OOP) costs of LCPT vs IR-Tac in kidney transplant patients, including the use of financial assistance, and found that at an institution with patient assistance grants, patients are less likely to have high out of pocket costs with LCPT compared to those prescribed IR-Tac.

This Viewpoint paper describes programs that employers, health plans, and other payers are using to reduce their own spending on specialty drugs including copay accumulator and maximizer programs and alternative funding programs.

This study found that health system specialty pharmacist interventions in MS can lead to substantial direct and indirect cost avoidance-up to $156,265 within a 6-month time frame. Most costs were avoided directly by preventing the dispensing of inappropriate therapies and indirectly by preventing additional health care utilization.

This case series identified patients with multiple sclerosis whose lymphocyte counts were stable on dimethyl fumarate, and then subsequently developed lymphopenia after switching to diroximel fumarate, prompting its discontinuation.

We compared rates of PMN, TAT, PDC, and persistence between an HSSP and external specialty pharmacies. Prescriptions sent to non-HSSP specialty pharmacies 60% more likely to experience PMN than prescriptions sent to an HSSP. Patients filling with an HSSP had higher adherence. Patients with inflammatory conditions filling with the HSSP had shorter turnaround time and higher persistence. Patients with MS who filled with the HSSP had higher PDC.