Specialty Drug Costs Impacts on Group Health

Packs of pills

Indiana Health Insurance updates on Speciality Drugs

Specialty pharmaceuticals are drugs created to treat patients with complex diseases.

In the last 12 months, there has been alarming trends on prescription drug costs. It is now estimated, that specialty RX is closing in on 30% of the medical spend. A group could have just 4% of membership utilizing specialty medications, that could represent 26% of the medical spend. The cost of these medications is having huge impacts.

What is being done to control these costs?

Insurance companies have started to address this issue for both fully insured and self-funded.

Drug formulary changes:

  • Carriers have already started to optimize their preferred drugs.
  • Anxiety drugs like Ativan that cost $1,572 a month have generic drugs in the same class cost $8-$52 a month.
  • Diabetes drugs like Fortamet cost $2,061 a month and there are drugs in the same class from $4 – $600 a month.
  • Carriers have already started removing the high costing drugs, but providing the lower costing alternatives.
  • Carriers are also getting creative with drug manufactures. They have created cost effectiveness programs, essentially a pay for performance agreement based on health outcomes.
  • If a diabetes drug can reach a A1c goal for patients.
  • If a multiple sclerosis drug lowers the rate of hospitalization.
  • High cholesterol drug reduces bad cholesterol levels.
  • Heart drugs to lower heart failure rate.
  • Hepatitis C drug cures Hepatitis.

Indiana Health Insurance Pharmaceutical Costs

These are real life examples of trying to control pharmaceutical costs. The fact that some drugs are not meeting performance benchmarks, should be alarming to everyone.

We are just now seeing the insurance industry start to manage these costs. Though responsible management programs RX cost should be controlled and we could even see medical costs also reduced.

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