Specialty Drugs Continue to Rise in Costs

Pinnacle Claims Management Specialty Drugs

You may have seen the story in September involving a CEO of a pharmaceutical company who, after recently buying the company, raised the price of their specialty medicine Daraprim from $13.50 to $750 a pill – an increase of 4,000%! The medicine has been around for more than six decades, helping patients with compromised immune systems (such as those with HIV-Aids or cancer) to battle a food-borne illness called toxoplasmosis. It appeared to all who followed this story that, no matter how it was explained, greed was clearly the driving factor for increasing the drug’s price. In response to the media and patient backlash, the CEO said that he would lower the price, although the new cost is unknown.

Welcome to the world of specialty drugs. We are thankful for what they can do to help patients with health conditions but are at the mercy of pharmaceutical companies that continue to raise their prices to unsustainable levels. While not all Pharma. company CEOs raise their prices as high as the one who was in the media recently, a recent article in Benefitspro.com reported that a survey of 60 leading health care vendors showed that specialty drugs are estimated to rise nearly 23% in the coming year and rose an estimated 18% over the past 12 months. Regular prescription drugs are estimated to increase by 10% in the coming year. 

There are some highly sought after specialty drugs coming down the line that will help with illnesses such as cancer or chronic conditions such as high cholesterol, and we are thankful for what they can do. But the costs are staggering and a recent study showed that while employees typically use less than one percent of specialty drugs, the cost is equivalent to 25% of an employer’s total prescription drug costs. Although costs are on the rise, a pharmacy benefit manager (PBM) can implement programs to help employers keep specialty drug costs lower for the coming year.