A new report finds that costs for specialty drugs are taking an outsized toll on payers, including health plans, union health plans and employers. More people are using specialty drugs. And, today, more than half of all health care spending on drugs is for specialty drugs, reports Kristen Smithberg for Benefits Pro
Addressing the cost of specialty drugs ranks as a foremost priority among payers. More than four in ten respondents surveyed (43 percent) ranked this issue first among their concerns. Thirty-seven percent of respondents ranked total cost of care at the top of their list. Few believed promoting transparency, addressing inappropriate use of care or improving patient satisfaction to be top health care priorities.
Their biggest challenge is the complexity of health care coverage. It’s hard to know what new drugs should be covered and for what conditions. Moreover, formulary design is also tricky. Should there be one tier for specialty drugs, as about half of plans have, or many tiers?
Next up, of concern to health plans and employers alike, is the increasing role of costly gene and cell therapies in treating complex conditions. These therapies are poised to treat more diseases in the coming years. But, they come with huge price tags.
Payers get rebates on specialty drugs. But, the rebates do not contain their costs as much as restricting their use. It’s more than likely that health plans and employers will find ways to deny coverage of these specialty drugs.
Here’s more from Just Care:
- How Ohio saved tens of millions by cutting the pharmacy middlemen out of Medicaid
- Lowering drug prices will not affect innovation
- Drug costs: A big chunk of your insurance premium
- Case study: Costco saves one couple hundreds of dollars over Medicare Part D
- Online pharmacies can save you money
