Specialty Rx by the Numbers

Top 3 Things You’ll Learn

  • How pharmacy benefits plans are impacted by specialty medications
  • The role of prior authorizations in managing appropriate specialty drug utilization
  • Projected increases in specialty drug spending and rebate yield over time

As more innovative specialty drug therapies hit the market this year, it’s important to re-evaluate your strategy to manage the appropriate use of these high-cost treatments. To shed some light on the true impact of specialty drugs on pharmacy benefits costs, we’re building a list of the top specialty Rx statistics.

To shed light on the true impact of specialty drugs on pharmacy benefits, check out this list of our top 10 specialty Rx stats. #drugcosts

# 1

One high-cost specialty drug is all it takes to experience a potentially catastrophic claim that could cost your plan more than $250,000 in a single year.


Two percent of a plan’s prescription drug claims will account for 50% of total plan cost this year


One out of three prior authorizations do not meet clinical criteria for appropriate utilization or are changed to a more appropriate therapy.


Prescription drug claims over $250,000/year represent four percent of plan cost and 1 in 12,500 members (0.008%).


One out of five medications stopped for an authorization requirement will ever be reviewed- meaning that four out of five drugs stopped for an authorization requirement will be changed to something else, was substituted for an OTC agent or was not necessary to begin with.


One out of every six people utilizes a prescription drug on a regular basis.


The average anticipated growth in prescription drug spending between 2020 and 2024 is approaching seven.


The average prescription drug rebate yield has increased eight percent from 17% to 25% over the past two years, while overall drug trend has remained in single digits.


The average compounded rate of inflation for a specialty medication between 2016 and 2020 is nine percent per year. The AWP in 2016 for a specific specialty item was $4,157 in 2016 and was $6,300 by 2020.


The top ten specialty medications by plan spend, according to RxBenefits’ 2019 book of business analysis.

1) Humira
2) Enbrel
3) Stelara
4) Humira (CF)
5) Cosentyx
6) Tecfidera
7) Truvada
8) Revlimid
9) Otezla
10) Gilenya

Ultimately, managing appropriate use of specialty medications require strategies that go beyond traditional pharmacy management. Ask yourself these questions when evaluating your specialty drug plan: Do I have visibility into the pharmacy arrangement to address any potential issues? How will my plan handle a new specialty drug that comes to market? Is the clinical framework able to respond appropriately to meet the plan’s objectives? 

Making sure that you understand your formulary, your utilization management programs, and that you are keeping an eye out for costly drugs with little-to-know clinical value is your key to success in managing the pharmacy benefit.

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