How New Drug Approvals Are Impacting Your Pharmacy Plan

Specialty spend is estimated to reach close to 50% by the end of 2020, and this trend is expected to continue given manufacturers’ continuing focus on developing new drugs that treat rare conditions. The specialty drug trend has created a greater need for you to carefully manage your pharmacy benefit spending to ensure that your plan’s prescription drug utilization is appropriate and that you aren’t paying unnecessarily for high-cost medications.

As new specialty drugs are approved, high price tags will continue to show the need for proactive management in Rx plans. #drugcosts

Bradley Nelson, PharmD

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Part of the challenge is that there is no one universal definition of a specialty medication, but medication cost usually plays a role in when the designation is applied. Each manufacturer and/or pharmacy benefit manager (PBM) determines which drugs qualify as specialty drugs and which are placed on the PBM drug lists. Traditionally, the specialty medication classification is used for:

• Drugs that are high-cost, highly complex and/or high touch
• Non-insulin biologics, which means that drugs are derived from living cells and not easily reproducible
• Injectables or infused medications (although some are oral medications)
• Drugs that treat complex or rare chronic conditions, such as cancer, rheumatoid arthritis, hemophilia, psoriasis, inflammatory bowel disease, and hepatitis C

As new specialty drugs are approved and become available in the market, the high price tags will continue to shine a light on the need for proactive contract and clinical management of your clients’ pharmacy benefits plans. A proactive contract management assists in controlling existing specialty utilization costs, while a foundational clinical strategy helps to manage appropriate drug use today and in the future. A comprehensive approach to managing prescription drug costs will be increasingly vital to maintaining sustainable employer pharmacy benefits.

Check out some of the specialty drugs that were recently approved by the Food and Drug Administration (FD) or are pending FDA approval later this year:

• FDA Approves Biologic Teprotumumab, First Drug for Thyroid Eye Disease
• FDA Approves Palforzia as First Treatment for Peanut Allergy
• Alzheimer’s Drug: The Search for a Cure
• FDA Accepts Applications for Ozanimod to Treat Relapsing Forms of MS