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Specialty drugs bring about high costs for employers

Only a small amount of the population uses specialty medications, but the cost of these drugs has grown between 15 and 20 percent in the last few years and accounted for all drug expenditures in 2009, according to the 2012 Specialty Drug Benefit Report. In the coming years, the cost of these medications is expected to outpace that of non-specialty drugs because a large portion of newly approved medications will be specialty, competition will remain scarce and manufacturing costs are expected to stay high.

Faced with these predictions, employers are becoming more focused on managing associated costs. However, many are finding it difficult because unlike antibiotics and other more common drugs, specialty meds can be covered under various plans.

"There's no one place you can go to see what your specialty drug spend is because you have to look in three different buckets—medical plan, pharmacy plan or through the various vendors," David Dross of Mercer's managed pharmacy consulting group, told Workforce magazine. "This is the most confounding part of the pharmacy puzzle."

In addition, specialty drugs can be distributed by retail and specialty pharmacies, a physician's office, a home health agency and other providers.

National Insurance Services is not a law firm and no opinion, suggestion, or recommendation of the firm or its employees shall constitute legal advice. Readers are advised to consult with their own attorney for a determination of their legal rights, responsibilities and liabilities, including the interpretation of any statute or regulation, or its application to the readers’ business activities.

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Valerie Ortiz

Valerie Ortiz

Over the past 20 years, Valerie Ortiz has worn many hats at National Insurance Services. She currently heads up NIS’ Marketing Team where she helps to create and execute employee benefit communications based upon our public sector clients’ needs. Valerie brings order to the chaos and has a zeal for detail and a talent for organization.