Specialty drug costs on the rise
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The cost and use of specialty drugs continued to increase in 2016 for both the managed and unmanaged populations, according to Coventry’s fourth Drug Trends Series report this year.
Specialty medications represent a relatively low volume of prescriptions in the workers compensation market, but “ongoing monitoring of these drugs is necessary due to their high cost and complex adherence requirements,” Coventry said in the report released Thursday.
The report found that costs associated with specialty medications increased 1.1 percentage points from 3.8% in 2015 to 4.9% in 2016. Managed specialty medications saw a 19.4% increase in scripts per claim and 7.9% increase in cost. Unmanaged specialty medications saw a 3.4% increase in scripts per claim and 29.5% increase in cost.
State-mandated closed formularies, preferred drug lists and medical treatment guidelines are the primary forms of regulation. Nebraska, Montana and New York have adopted state formularies. Illinois, Pennsylvania and Louisiana have proposed state formularies, according to the report.
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Employers in a bind over specialty drugs
As specialty drug costs help push U.S. health care spending and health plan costs to new heights, employers have to balance managing those costs while ensuring sick workers get drugs that may save their lives.
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