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Life Health > Health Insurance

Employers try to rein in specialty drug costs

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As the price of specialty drugs continue to rise, employers are desperately seeking to rein in their health care costs. 

According to a recent survey of 487 large employers by Towers Watson and the National Business Group on Health, 80 percent of firms said that design changes to health and pharmacy plans represents the most significant strategic priority over the next three years. 

More than half of employers (53 percent) said they have imposed new restrictions on specialty drugs, such as requiring prior authorization for prescriptions or limiting use based on clinical evidence. By 2018, a full 85 percent of employers plan to have such restrictions in place. 

Employers are also increasingly not covering certain compounds that are prescribed by doctors and designed by pharmacists to address specific patients. The process of developing a patient-specific medication of course adds cost to the treatment, and some of the compounds may not be FDA-approved. Employers are identifying both of those points as reasons to exclude “inappropriate compounds” from their plans. 

“Left unchecked, pharmacy costs will continue to soar, creating an urgent need for employers to reevaluate their pharmacy plans and benefits to include maximizing use of generic drugs, and develop clear policies on the use of specialty and compound drugs,” said Carmelina Rivera, U.S. West Division pharmacy leader for Towers Watson. “The challenge is to prudently manage pharmacy costs while enabling employees to access effective and affordable treatment.” 

Responding to concerns over drug prices, the American College of Physicians recently recommended that doctors prescribe generic medications over name-brand drugs whenever possible. Not only do generics ease the financial burden on patients and their insurers, but their lower cost makes it more likely that the patient will refill the prescription and take the medication as needed. 

Congressional leaders have also been alarmed by dramatic price increases for certain specialty drugs, and have called on pharmaceutical executives to explain some of the most notable price hikes for drugs treating HIV, cancer, hepatitis C and other life-threatening conditions. 


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