Specialty Medications - Bull-by-the-horns or Just Keeping an Eye on It?

If you’re managing a self-funded health plan in 2021, I’m certain you’re becoming more and more familiar with specialty medications.?For most, this topic is on the minds of employers I talk to – However, I’m still consistently coming across employers who don’t yet have the bull by the horns so-to-speak.??They don’t yet have a plan.

Beyond traditional medicines, specialty drugs have arrived on the scene and are significantly increasing pharmacy benefit budgets. This trend isn’t slowing any time soon. ?And, taking a wait & see approach or keep an eye on it mindset is the farthest from what you want to do…..

To give you a little background …

There’s many subsets of Specialty Drugs, including gene therapies which are the newest category to the FDA approval scene. Gene therapies are for rare genetic diseases with high morbidity and few or no treatment options.

Due to the mapping of the human genome, now more than 6,000 clinical trials are being conducted to see if altered genes can literally treat or even cure diseases like blindness, hemophilia, sickle cell anemia, and cancer.

While these are exciting and potentially curative therapies, in some instances, the cost is astronomical. They range in price from tens of thousands of dollars per course of treatment to over $2 million per treatment, and the new potential gene therapies coming to market are speculated to cost even more.

Another subset of Specialty meds are Orphan Drugs.?The Orphan Drug Act of 1983 incentivized manufacturers to research and bring therapies to market – therapies and medications that address rare diseases – those that affects fewer than 200,000 people in the US.?The average annual orphan drug cost rose from $7,136 in 1997 to $186,758 in 2017.?Orphan drugs are now 25x more expensive than non-orphan drugs.?And, finally, as of 2019, 88% of orphan drugs cost more than $10,000 per year per patient.

There is nothing around me, in my world that indicates these trends are slowing.?And, again, taking a wait & see approach or having a keep an eye on it mindset brings nothing but unmitigated risk and unbridled cost potential.??

So, a ton of opportunity here.?You’ve got to set these conversations in motion and ensure you’ve got the right professionals in your corner with careful monitoring throughout the year.

We’re here to help.?If you’d like to dig deeper into these conversations, let’s talk.?

Message me on LinkedIn or at visit slong.apexbg.com to connect further.