One of the fastest growing areas of healthcare costs are Specialty Drugs. There are many of the high-end expensive drugs you see advertised on TV. Depending upon the source, Specialty Drugs are defined as those that cost between $300 and $400 per month.

I’ve met with many employers who continue to have prescription drug costs rising at incredible rates. It’s no surprise when you look at these Specialty Drug examples, that their healthcare their company’s total healthcare spend is increasing rapidly.  Take a look at the cost of these examples:

Prezcobix: $20,568                Lyrica:  $5,088

Humalog:  $16,800                 Lantus:  $9,180

Enbrel:  $54,600                     Humira:  $50,400

Xsareto:  $4,776                     Lialdo:  $12,660

Trulicity:  $8,304                    Truvada:  $19,200

Orkambia:  $259,000

Some employers have told me that their Specialty Drugs comprise up 20 of 25% of their entire drug spend! This isn’t going to go down, in fact it’s going to rise rapidly as there are over 5,000 specialty drugs in development right now for a future release to the marketplace.

One solution I have found is a Specialty Drug and prescription drug advocacy program. The program is funded from a variety of sources including grants, foundations, drug manufacturers, disease manufacturers, and other wealthy donors. This program offers over 1,700 different drugs to qualified members of an employers group. It’s a voluntary program and one which an employee or family member can enroll by simply entering their information and the drug that they may be taking.

If the member (and their drug) qualifies, the drug is available at little or no cost to the member – and the drug doesn’t even show up as a claim for the employer!  Imagine some of the drugs above having to no longer be included on the employers claim experience.  What a savings!

Here are a couple of examples of clients who have had ONLY a few members sign up in just ONE MONTH.

Type of Medication Medication Name     Advocacy Price         Retail Price        Saved vs Retail
 Employer A
Brand Nasonex  $                       –  $              326.00  $                   326.00
Brand Lyrica  $                       –  $              568.00  $                      568.00
Brand Toujeo  $                       –  $          1,211.00  $                  1,211.00
Generic Valacyclovir  $                   7.25  $              232.00  $                      224.75
Specialty Avonex  $                       –  $          7,836.00  $                  7,836.00
Brand Humira  $                       –  $          5,896.00  $                  5,896.00
 Monthly Savings    $                   7.25  $        16,069.00  $                16,061.75
 Employer B
Specialty Remicaid  $                       –  $        11,639.00  $                11,639.00
Generic Levothyroxine  $                   6.66  $                36.00  $                        29.34
Brand Lyrica  $                       –  $              468.00  $                      468.00
Brand Victoza  $                       –  $          1,193.00  $                  1,193.00
Monthly Savings    $                   6.66  $        13,336.00  $                13,329.34

I recently read an article where it’s expected that a soon-to-be released drug for hemophilia will exceed $1,000,000 per year.  Ho can afford these drugs?  What plan can afford these drugs?  Many of these drugs will require a either a laser from the underwriter, or an extremely large increase in premiums, or both.

The good news is that there are very effective plan designs that can reduce or eliminate the cost of these drugs from a plan, while still providing the drug to the member on a cost effective basis, as you can see above.  I’m not talking about a coupon, or the typical program through your Pharmacy Benefit Manager. These are cutting edge programs, and if you’d like to learn more about what you can do to lower your Specialty Drug costs, please email me at frank.stichter@strategichpc.com or call me at either 970.349.7707 or 419.725.1088.  I look forward to sharing some ideas!