Understanding & Taking Control of Your Specialty Drug Spending

It's no surprise that healthcare spending continues to rise at an alarming rate. As an increasing factor of healthcare cost, the future costs of specialty drugs are of growing concern. Specialty drugs offer hope and promise for patients and their families who suffer from severe and often life-threatening diseases. However, specialty drugs are very costly, which can tempt employers to cut coverage from plans because they don't know of another solution for dealing with these expenses. Well, Synergy Pharmacy Benefit Consultants is about to change that. This week, we're educating our readers on what specialty drugs are, their impact, and how to save on specialty drug costs without limiting the availability of them to your employees.

What is a Specialty Drug?
Specialty drugs are high-cost prescription medications used to treat complex, chronic conditions like cancer, rheumatoid arthritis and multiple sclerosis. Often times, a patient using a specialty drug requires monitoring to ensure the drug is working and to keep an eye out for side effects. These life-saving drugs are typically very expensive with a full pipeline of future specialty medications on the horizon.

What is the Impact of Specialty Pharmacy?
Significant breakthroughs in medical innovation over the last few decades have spurred the development and availability of increasing numbers of specialty drugs for rare diseases. Specialty pharmaceuticals provide critically needed treatments for some of the most debilitating conditions, such as multiple sclerosis, some cancers, rheumatoid arthritis, hemophilia and hepatitis, which affect millions of people in the U.S. and around the globe.

Why are Specialty Drugs so Costly?
Used by only 1% to 3% of plan members, specialty drug spending accounts for roughly 30% of healthcare costs, and growing. For as important as these drugs are, the costs for coverage tend to be far out of reach for the many who need them. There are several reasons behind this issue. One is that employees are using their prescription drug plan incorrectly, more than likely unbeknownst to them. So educating employees of what their drug plan covers and how to effectively use it is a huge money saver. Another issue is that there are administrative errors being made that are causing over charging and system errors. Third, without ongoing claims auditing and clinical oversight, employers can be spending way more on their prescription drug costs than needed. 

What Can Be Done to Save on Specialty Drugs?
A PBM audit is a potential opportunity to recover funds lost through over payment or system errors. It can help to identify parts of a plan that may need improvement, areas that could be cut to preserve spending, clinical alternatives resulting in huge savings, and can show you areas in which you can save money by adjusting copays and modifying the drug list.

So, if you're a self funded employer who feels you're paying way too much for your prescription drug plan – we have solutions for you! Contact a trusted and experienced Pharmacy Benefit Management consultant today to complete a FREE no obligation claims analysis! We'll help you pinpoint the areas that need improvement and help you save money in the process.

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Synergy Pharmacy Benefit Consultants, LLC
2111 Bagnell Dam Blvd #37
Lake Ozark, MO 65049


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