What Are Specialty Drugs And How Do They Impact Premiums?

Specialty drugs are expensive medications that are used to treat complex, chronic medical conditions.  They are often given by injection or infusion and are potential life savers for patients undergoing treatment of various cancers, rheumatoid arthritis, multiple sclerosis and other rare diseases.  Most of these drugs require special handling, administration and monitoring to assure patient safety and as a result, are not normally stocked by local retail pharmacies, but rather by “specialty pharmacies.” 

Specialty drug availability has risen dramatically since the mid-1990s, when there were only a few specialty drugs on the market.  Today, there are hundreds of specialty drugs available.  This rapid increase in specialty drug spending has placed an enormous burden on employers and those they insure, as these higher drug costs have translated into much higher prescription drug premiums.  This in turn has created an urgent need for substantial changes to our country’s pharmacy and drug therapy management system.  

Insurers, pharmacy benefit managers and employers have responded by incorporating specific strategies to control the use and costs of specialty drugs, including pre-certification, the use of tiered formularies, and the required use of lowest cost administration sites.  But as specialty drugs continue to account for an increasingly significant portion of overall health care spending, new strategies will be needed to enable patients continued access to these beneficial drugs while controlling their rapid rise in cost. 

My Benefit Advisor (MBA) guides employers of all sizes through planning, communicating, and managing a successful employee benefits program.  We are ready to help you find the solution that fits your needs, from group insurance to individual coverage.  For more information about MBA, contact us.