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Evolving Health Policy Dynamics of High Cost Specialty Drugs

(266 reviews)

Produced on February 24, 2017

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Course Information

Time 1h 1m
Difficulty Intermediate
Topics covered in this course: Health Care Life Sciences

Course Description

Federal spending on the Medicare program for people with high drug costs has dramatically increased over the past five years, which is largely due to the soaring costs of expensive specialty medications, according to a January 2017 report from the Department of Health and Human Services. As the Wall Street Journal has noted, federal payments for Medicare Part D catastrophic coverage, which pays 80% of drug costs after a beneficiary has spent a certain amount annually, surpassed $33 billion in 2015, more than triple the amount paid in 2010. Most of this rise is due to increased spending on drugs that cost $1,000 or more a month, several of which came on the market in the last few years.

These high cost specialty drugs impact a range of stakeholders form payers, pharma, physicians, patients, and policymakers, and present complex legal issues ranging from Fraud & Abuse to compliance with FDA Marketing & Communications.

This course, presented by Rujul Desai, Vice President of Avalere Health, is designed to help attendees understand the unique dynamics of the specialty drug market in order to better advise clients on the legal, regulatory, and policy risks in today’s evolving healthcare landscape.

Learning Objectives: 

  1. Understand the impact of high cost specialty drugs on overall healthcare spending trends

  2. Outline the market access and distribution process for specialty drugs

  3. Review recent attempts to address some of the cost pressure through innovative contracting

  4. Identify key areas of legal risk for various stakeholders associated with the unique dynamics of the specialty drug marketplace

  5. Discuss recent enforcement trends focusing on the specialty drug market

Credit Information

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Rujul Desai

Avalere Health

Rujul Desai, Vice President Avalere Health, advises clients on market access, reimbursement, strategic contracting and regulatory solutions. He applies his unique combination of experience in specialty pharmacy, biopharma, PBM, legal and regulatory services. Prior to joining Avalere, Rujul has held a number of leadership roles in the specialty industry, including at CVS Caremark, UCB, and Theracom.

He was also the founder of a specialty hub services company supporting biopharma products. Rujul has significant health law experience, including practicing at the law firm of K&L Gates. Rujul holds a JD from University of Houston and a BA from Rutgers University. He is a combat veteran of the Global War on Terror, U.S. Army, Medical Service Corps, Captain (Ret.).


Christopher B.

Excellent introduction to a complex and increasingly important area; thank you!

Adaline K.

Very informative and helpful discussion of major stakeholder interests and interplay in the area of specialty drug pricing. Thanks.

Eric F.

Course was outstanding. Great job of explaining complicated issues in a digestable way.

Catherine T.

Best teacher I have seen on lawline and many of your teachers are excellent

Julie A. B.

Watch this program to better understand the subtleties of the specialty drug market as well as any associated legal, regulatory, and policy risks.

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