Plans Change Tactics As Costs Keep Rising For Specialty Drugs

Based on the current trend, with specialty drug costs growing annually by 20 percent, they will account for more than a quarter of all outpatient pharmacy expenditures by 2008. These findings were reported in CuraScript’s Specialty Pharmacy Management Guide and Trend Report, an annual guide highlighting the effects of specialty drug costs on employers’ health care plans.

Average drug copayments for preferred ($22), nonpreferred ($35), and generic ($10) drugs have increased slightly over 2004 levels. Nevertheless, drug copayments for fourth-tier drugs, typically biotech and “lifestyle” drugs, increased 54 percent in 2005, according to survey results.

CuraScript reports that in an effort to get a handle on rising medical costs, a significant number of their clients are saving by ensuring that self-administered drugs are not administered in the physician’s office, unless the patient’s health status prevents self-administration. The report indicates a shift away from covering specialty drugs under the medical benefit, regardless of whether they are administered by the patient or by a clinician.

CuraScript expects to see a significant shift in the percentage of plans exclusively classifying specialty drugs under the medical benefit. By the end of 2005, the number of clients classifying specialty drugs under the pharmacy benefit will more than double, and specialty products covered under the medical benefit are expected to be cut in half.

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