Specialty Drugs: A Key Contributor to High-Cost Claims

With the increasing trend toward self-funding, reinsurance is a way of mitigating the financial impact of high cost claims. A major concern for employer groups and carriers alike is the increased number and utilization of expensive specialty drugs driving up the cost and unpredictability of catastrophic claims.

The American Journal of Managed Care reports that in 1990 there were 10 specialty drugs on the market. In 2012, there were nearly 300. Astonishingly, 40 percent of drugs in the pharmaceutical pipeline will be specialty drugs once they hit the market.
Some industry analysts have predicted that by 2017, 45 percent of total drug spend will be on specialty drugs.

specialty-drugs-graph

The specialty drug pipeline is filled with:

  • New types of therapies for more-common conditions, such as oral drugs to replace those that were previously injected to treat cancer, autoimmune and other familiar diseases
  • Costly therapies for less-common conditions like hemophilia, growth hormone deficiencies, and others

We thought some information on the pipeline for specialty drugs would be useful to you. The Specialty Pharmacy Pipeline Report prepared by our Resources Program partner, Excelsior Solutions, explores why there have been such significant changes in the cost of specialty pharmacy in recent years and gives details of 18 drugs in the pipeline for 2014-2015 with expected per-patient costs of up to $300,000 a year.

Download the “Specialty Pharmacy Pipeline Report”

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