Top 3 Things You’ll Learn
- How employer-sponsored pharmacy benefits plans are impacted by specialty medications
- Medications and conditions driving specialty drug spend
- Average increases in high-cost specialty medications
As more innovative specialty drug therapies hit the market in 2021, it is important to re-evaluate your pharmacy benefits management strategy to address the appropriate use of these high-cost treatments. To shed some light on the true impact of specialty drugs on self-funded employer pharmacy benefits costs, we’ve compiled a list of our 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 numbers to know this year. #drugcosts
One high-cost specialty drug designed to treat a rare condition (impacting less than 200K Americans) is all it takes to experience plan costs of more than $250,000 for a given claimant in a single year.
Two percent of a plan’s prescription drug claims will account for 50% of total pharmacy benefits plan costs this year.
Three-month fills of specialty medications, such as Skyrizi® and Stelara®, relative to all medications have increased utilizers by 38.7%, and pharmacy claims by 48.9% between 2019 and 2020.
Four injections per month for Humira® is indicative of “dose creep,” a phenomenon that is on the rise as providers work to max out dosing for conditions such as Ulcerative Colitis and Crohn’s disease.
Certain conditions are plagued by high-cost treatment options more often than others. Five disease states to watch in 2021 are:
2. Anti-Inflammatory Conditions (Crohn’s disease, Psoriasis, Atopic Dermatitis)
3. Hereditary Angioedema
5. Cystic Fibrosis
The average increase in spending for HIV medications approached six percent in 2020 (over 2019), driven by increased utilization of higher-cost agents despite the generic anticipated launch of generic Truvada®.
The average increase in per unit cost in cancer medications approached seven percent in 2020 (over 2019) as new cancer medications or new indications for existing medications were approved.
Based on consolidated Medi-Span Average Wholesale Price (AWP) data, the AWP on the best-selling specialty medication by total spend, Humira, doubled over an eight-year period.
Per the Pharmaceutical Care Management Association, a PBM trade group, nine of the 10 best-selling drugs by revenue will come from the specialty channel, compared to three in 2010 and seven in 2014.
The top ten specialty medications by gross spend, according to RxBenefits’ 2020 book of business analysis:
10) Xeljanz/Xeljanz XR®
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 drug formulary, your pharmacy benefits utilization management programs, and that you are keeping an eye out for costly prescription drugs with little-to-know clinical value is your key to success in pharmacy benefits management.
Watch our on-demand webinar to learn how a tailored clinical strategy can help self-funded employers manage their specialty drug costs.