Rising costs, rising concerns: specialty drug costs worry employer-sponsored health plans

Specialty drugs are designed to fight serious and chronic diseases and conditions such as cancer, HIV/AIDS, heart disease, multiple sclerosis, Hepatitis C and high cholesterol. However, the high cost of these medications is on the minds of many in the health care and employer sectors, with employer-sponsored health plans especially impacted. Specialty drugs are a rising expense across the health care spectrum – and in some cases, the costs are skyrocketing.

Consider these points:

*As BenefitsPro.com notes, some specialty drugs can range in price from $50,000 to in excess of $100,000 per year. That’s why in many cases, companies and their health insurers behind their employer-sponsored health plans want participants to go through a specific pharmacy benefit manager (PBM) to get the most expensive medications.

*With a wave of new specialty drugs hitting the market over the last several years, the affordability issue won’t go away, especially when the medications are being used to address pressing health issues. For instance, two new cholesterol drugs — Repatha and Praulent — are expected to cost between $7,000 and $12,000 per year, according to U.S. News and World Report.

Given the high costs and high need for specialty drugs, it’s only natural pressure could be brought to bear on drug makers to share information on how they price their medications. According to The New York Times, at least a half-dozen states have introduced bills that would require drug makers to be more forthcoming with such information. With employers, consumers, insurers, and lawmakers all focused on getting a handle on specialty drug costs, it is hopeful that positive results will soon follow.

To learn more about effective strategies for incorporating specialty drugs into an employer-sponsored health plan or about other strategic insurance and employee benefits solutions The Plexus Groupe provides, visit us at plexusgroupe.com or call Plexus at 847.307.6100 (Chicago) or 972-770-5010 (Dallas/Oklahoma). You can also contact us via the Web.

References

McDonald, Robert C. MD, MBA. Managing the Intersection of Medical and Pharmacy Benefits,” Supplement to Journal of Managed Care Pharmacy, Vol. 14, May 2008.

Wookdrudge, Scott. Rising cost of specialty drugs concerns employers.” BenefitsPro.com, 20 May 2015.

Sternberg, Steve. Groundbreaking Specialty Drugs Come With High Costs. U.S. News & World Report. 6 July 2015.

Pollack, Andrew. Drug Prices Soar, Prompting Calls for Justification.” The New York Times, 23 July 2015.