the high costs of specialty drugs infographic€¦ · to manage specialty drug spending,” center...
TRANSCRIPT
Specialty pharmaceuticals or “biologics” are developed to treat a small part of the population who suffer from rare, life-threatening or disabling diseases.
The growth in pharmaceutical costs is driving overall medical spending upward, with specialty drugs playing the most significant role in pharmaceutical spending growth.
1Johnson, Carolyn, “Specialty Drugs Now Cost More than the Median Household Income,” The Washington Post, November 20, 2015; 2IMS Health Study: US Drug Spending Growth Reaches 8.5 Percent in 2015, http://www.imshealth.com/en/about-us/news/ims-health-study-us-drug-spending-growth-reaches-8.5-percent-in-2015, April 14, 2016; 3Express Scripts 2015 Drug Trend Report Executive Summary, The Express Scripts Lab, March 2016; 4Specialty Drugs and Health Care Costs, The PEW Charitable Trusts, November 16, 2015; 5Limited Options to Manage Specialty Drug Spending,” Center for Stydying Health System Change, April 2012; 6“High Performance Insights Best Practices in Health Care,” 2015 20th Annual Willis Towers Watson/National Business Group on Health Best Practices in Health Care Employer Survey.
MTG-2871 (R6/16)
THE BASIC DIFFERENCES
TRADITIONAL TREATS:
Colds & flu, allergies, headaches, common
infections
SPECIALTY TREATS:
Cancer, Hepatitis C, Rheumatoid
Arthritis & M.S.
Traditional is used for basic health and wellnessSpecialty is used for complex, chronic conditions
VS
THE BIG DIFFERENCE?
Average specialty drug cost is $54K per year- more than the U.S. median household income1
$150.8B in specialty drug spending in 2015, with $400B on medicines expected by 20202
A DOSE OF REALITY 6 Less than 5%
Account for 50% of All Drug Spending by 2018
of Insureds Use Specialty Pharmacy Benefits
But They Will
Specialty Drug Development 4
Exclusivity Period Before Generics or Biosimilars Can be Produced 5
READ OUR FULL REPORT ABOUT SPECIALTY DRUGS ON HMIG.COM
HOW CAN THESE COSTS BE MANAGED?There are several actions that can be taken to help manage the costs associated with specialty drug benefits.
1 CARVE OUT THE PHARMACY BENEFIT – Moving as many pharmaceutical purchases from the medical benefit to the pharmacy benefit can reduce costs tied to facility charges.
2 REQUIRE PRE-AUTHORIZATION – When employers know a drug is being recommended for treatment, proper cost-containment practices can be used from the start.
3 LIMIT SPECIALTY DRUG DISPENSING – Employers can choose to limit dispensing to a 30-day supply, which can reduce costs and the potential for waste if a patient cannot tolerate the medication.
4 USE FOUR-TIER DRUG PLANS – These typically involve an increase in co-pays for the high-cost drugs.
5 CONTRACT WITH A WELL-VETTED SPECIALTY PHARMACY VENDOR – They have capabilities, certifications and accreditations to help ensure cost containment expectations will be met.
Pharmaceutical Spending
Traditional Specialty
700
600
500
400
300
200
100
0
In Market1990
In Market2015
In Development2015
12
10
8
6
4
2
0
Specialty DrugsTraditional Drugs
Prescriptions Written
Pharmaceutical Spending
Traditional Specialty
700
600
500
400
300
200
100
0
In Market1990
In Market2015
In Development2015
12
10
8
6
4
2
0
Specialty DrugsTraditional Drugs
Prescriptions Written
17.8% specialty growth versus -0.1% traditional growth3
Pharma Infographic_v8.indd 1 06/27/2016 1:24:07 PM