Specialty pharmacy continues to see annual increases in terms of U.S. spending on prescriptions for the treatment of complex or chronic diseases. URAC estimates that specialty drugs account for more than $50 billion of U.S. drug expenditures and comprises nearly 20 percent of the total pharmaceutical revenue. Specialty pharmacy is expected to make up approximately 40 percent of 2020 drug spending by health plans. Similarly, other predictions call for an uptick in specialty drug costs to reach 50% of health plans’ total drug spend by 2018.
But where does this leave the patient? On the one hand, new medications are a godsend offering more hope for previously under-treated diseases or providing better treatment outcomes with fewer side effects. Certainly this is the case with the new hepatitis C medications and many new cancer treatments. Yet, on the other hand, increased costs of the latest medications – which tend to be passed on to the patient – can leave many patients simply unable to afford a newly available cure or treatment. Hope, in these cases, can be just out of reach.
This is where patient assistance programs and specialty co-pay offset programs can fill in the gap for patients who are financially overburdened. In a recent review by a pharmacy benefit manager (Prime Therapeutics) shared at the Pharmacy Benefit Management Institute’s (PBMI) 2014 conference, more than a quarter-million prescription claims were examined. These prescriptions represented more than $900 million in drug spending. More than half of the almost 38,000 different patients associated with these prescriptions received help from patient assistance programs or manufacturer coupons, saving more than $21 million for the patients.
Approximately 400 different medications (traditional and specialty) have manufacturer coupons for patients to defray costs. These coupons are particularly useful for patients requiring a specialty medication which does not have a generic option available.
BioPlus Specialty Pharmacy has a thriving patient assistance program. In 2013, BioPlus assisted our patients in securing $7.2 million through patient assistance programs and co-pay assistance.
As costs in specialty pharmacy continue to rise for patients, it’s heartening to see manufacturers and other specialty pharmacies keep treatment hope within reach for patients through coupons and patient assistance programs.
Stephen C Vogt, PharmD
President and CEO
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PR Newswire. Prime Therapeutics Specialty Pharmacy helped nearly 20,000 members save $21.2 million on specialty medicines in 2013. February 4, 2014.
Ross JS, Kesselheim AS. Prescription-drug coupons — No such thing as a free lunch. N Engl J Med 2013;369:1188-9.
Stettin G. Specialty drug spending to jump 67% by 2015. Express Scripts Lab May 21, 2013.
URAC white paper. The patient-centered outgrowth of specialty pharmacy. URAC 2012.