Assay management, an important element of cost containment, requires rigorous oversight and reporting, which should be expected from any dispensing specialty pharmacy. Assay management is the process of filling a prescription as closely to the prescribed target dose as possible using one or more available clotting factor vials. Vials come in a range of unit or assay sizes. Factor pricing can vary significantly among dispensing pharmacies for the same product. Providers write prescriptions based on units per kilogram (U/kg) of patient weight. Tightly monitoring how much factor medication is dispensed through the specialty pharmacy helps an employer to reduce waste and better manage costs.
The National Hemophilia Foundation’s Medical Scientific Advisory Council recommends that factor should be dispensed within +/- 5% to +/- 10% of the prescribed target dose. Payers and employers can and should require tighter assay management; in most cases, +/- 1% to +/- 2% of the target dose can be achieved.
Prescription data is the actual prescription that sets the targeted dose to be dispensed. Employers do not traditionally have access to prescription data. However, they can and should require vendors to collect this information. Having actual prescription data provides the payer with transparency to verify the number of units dispensed, per unit cost and assay management.
Per unit prices differ among specialty/dispensing pharmacies. Hemophilia Treatment Centers are recognized by the federal government and have access to discounted medications under the 340B Drug Pricing Program, which may offer competitive and/or lower average pricing per unit.