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Report Outlines Steps to Manage High-Cost Specialty Drugs as Costs Rise

Benefit manager cites 19% increase in specialty spending last year (October 10)

According to a report from pharmacy benefit manager Prime Therapeutics LLC, rising costs and the increased use of specialty drugs are placing a greater financial burden on people, their employers, and their health plans.

Spending on high-cost specialty drugs used to treat complex diseases, such as cancer, increased more than 19% among Prime Therapeutics members in 2012. That increase differs greatly from the company’s 0.9% drop in traditional (all non-specialty) drug spending in 2012.

The new report outlines seven steps for employers and health plans to take control of specialty drug costs. These steps are:

  • Bridge the benefit divide: Use combined pharmacy and medical benefit data to see the full scope of specialty spending and seek solutions.
  • Focus on the biggest issues: Use combined data to target the most urgent issues and focus on the areas that can provide the greatest return on investment.
  • Narrow the specialty networks: Use cost-effective distribution channels and limit the number of distributors to secure lower costs.
  • Embrace a management mindset: Make sure the right specialty drugs are used properly by those who will benefit the most.
  • Promote preferred drug use: Build plans that encourage desired behaviors.
  • Protect members from high costs: Limit members’ out-of-pocket costs and use available tools to reduce the burden on highly vulnerable members.
  • Pick the right partner: Select a trusted advisor with comprehensive capabilities and deep connections to help anticipate and address specialty drug challenges.

According to the report, specialty drugs account for 30% of total drug costs, and that number is expected to reach 50% of total drug spending by 2018.

Source: Prime Therapeutics; October 10, 2013.

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