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The Lowdown on Specialty Drugs

Healthcare costs continue to be a concern, despite efforts underway to reduce them through healthcare reform initiatives.  One area, in particular, is worrying patients and physicians alike: specialty drugs or biologics. An article in Workforce Management reports that specialty drugs “make up about 17% of employers’ total drug costs, even though just 1% of the workforce takes them.”  Reuters reports that “approximately 57 million Americans rely on specialty drugs,” with the average prescription costing $1,766.00 in 2011.

03.27.13“Specialty drugs are high-cost drugs used to treat complex or rare conditions, such as multiple sclerosis, rheumatoid arthritis, hepatitis C and hemophilia. The drugs are often self-injected or administered in a physician’s office or through home health services,” according to Wellmark. Specialty pharmacies specialize in the delivery and clinical management of specialty drugs.  It is reported that the average cost per specialty medication is $2,000.00 per month, 10 times greater than that for nonspecialty medications, according to the 2012 Specialty Drug Benefit Report by the Pharmacy Benefit Management Institute, a research organization in Scottsdale, Arizona.

Why do specialty drugs cost so much? Workforce Management reports that “overall pharmacy spending is relatively low because of the number of drugs available in generic form, but specialty medications are derived from living organisms and have no substitute, unlike most drugs which are made chemically.”  The complexity involved in manufacturing biologics stems from the fact that these medicines are derived from living cells grown in vitro in a highly controlled environment. The risks for contamination, counterfeiting and drug shortages is higher as well.

But there are new developments that may make it easier and more affordable for patients to obtain their specialty drugs. In our next post, we will discuss the advent of “biosimilars,” and include tips on getting your insurance company to cover the costs of your biologic medications.

 

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