Limited Options to Manage Specialty Drug Spending

Spending on specialty drugs—typically high-cost biologics used to treat a variety of serious, complex conditions ranging from blood disorders to rheumatoid arthritis—has been growing at a persistently high rate in recent years. Although prescribed for only one in every 100 commercial health plan enrollees, they account for an estimated 12 to 16 percent of commercial prescription drug spending today.

Cost pressures have prompted some employers to increase patient cost-sharing of such medications. Health plans are experimenting with a range of innovations to control spending, but the most promising among them may not be feasible until substitutes, such as biosimilars, become widely available years from now.

To learn more about the cost challenges associated with these drugs and determine what cost-control options exist, researchers at the Center for Studying Health System Change conducted literature reviews and nearly 200 interviews with representatives of health plans, benefits consulting firms, pharmacy consulting firms and other industry experts.

Funded by the Robert Wood Johnson Foundation and the National Institute for Health Care Reform, this brief details the researchers’ findings.