Specialty Drugs – Managing The High Price Tag

Pinnacle RxSolutions

As an employer, it’s easy to have a love–hate relationship with specialty drugs. On one hand, these drugs can effectively treat and save money in the long run on chronic employee health conditions such as cancer, rheumatoid arthritis, Crohn’s disease and multiple sclerosis. But on the other hand, they are costly medications that are increasing your pharmacy costs annually. In this post, we will discuss the high cost of specialty drugs and suggestions on how to manage the costs better. 

Recent news stories have been focusing on the skyrocketing costs of specialty drugs and how some employers are passing along those costs to consumers. For example, CBS’s local show HealthWatch in the San Francisco Bay Area reported last month that they are seeing a trend in employers quietly changing the way they are paying for specialty drugs.

Employers are moving from traditional employee co-pays to having employees pay a percentage of the total cost of the specialty drug. This can result in a 5x price increase or more for employees, meaning a drug costing less than $50 a prescription will now cost $225 for the same item. This way of cost sharing passes along a portion of the additional costs to the employees who use them instead of sharing the cost over the entire employee population.

Moreover, a recent health care study announced that specialty medications made up more than 30 percent of total drug spending in 2014 and will continue to increase in subsequent years. According to Elaine Rockney, a licensed pharmacist and Senior Vice President with ARMS Rx, a pharmacy benefit consulting firm, the percentage of specialty meds will increase to 50 percent by 2020. “While specialty drugs continue to go up in cost and that is frustrating, they also play an important role in keeping employees healthy and productive by helping manage their conditions so they don’t become more costly down the road for employers,” Rockney added.

To help improve your outcomes and reduce costs with specialty drugs, you will want to partner with a good Pharmacy Benefit Manager (PBM), one like Pinnacle RxSolutions, that offers services to help in that area. A good Rx partner will:

  • Perform a diagnostic test to make sure the employee is given the right diagnosis of the disease and confirm what stage they are in before a pre-authorization is given. This process will help optimize the right dosage level recommended for the patient.
  • Provide proper communication and counseling before a specialty medication is prescribed so the employee is fully aware of the potential side effects of the medication. This is to prevent the employee from discontinuing the medication because of side effects they were not aware might happen.
  • Offer patient coordination and adherence programs to ensure an employee is taking the proper dosage level at the right time.
  • Notify clients when FDA approves bio-similar drugs, which are a specialty version of a generic drug. The very first bio-similar specialty drug will be available soon so employers are eager to see what kind of discount these “generic” specialty drugs will provide.