Rising cost of ‘specialty’ drugs prompts employers to limit their use

By Michelle Andrews, 

The coinsurance was killing them. “It was a choice between that and eating,” Gary Ryness says.

Working with an insurance consultant, they switched from a preferred provider organization to a health maintenance organization that didn’t have coinsurance charges for self-injectable drugs such as Avonex. Now, they pay nothing for the drug.

“Everybody has different ways of classifying these drugs,” Gary says.

In coming years, experts say, more people will have to navigate the confusing and expensive terrain of such “specialty” medications.

While most drugs are made from chemicals and can have generic as well as brand-name versions, a typical specialty drug is biologic — that is, derived from living organisms — and has no substitute. In addition to treating MS, these drugs are used for such complex, serious conditions as cancer, rheumatoid arthritis and Crohn’s disease. Growth in spending on specialty drugs is far outpacing spending on traditional drugs, and many new onesare in the pipeline.

“In the next five to 10 years, the consensus of all the experts we spoke to was that a much larger proportion of consumers will be eligible for some kind of specialty drug,” says Ha Tu, a senior researcher at the Center for Studying Health System Change. She was the lead author on a recent report about managing spending on specialty drugs.

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