Insurers' spending on specialty drugs has jumped, study says

Hand holding pills and a pill packet

New research adds even more credence to health insurers’ concerns about the rising costs of pharmaceuticals.  

The study, published in Health Affairs, looked specifically at specialty prescription drugs, which in recent years have been leading contributors to health plan spending. Among the findings:

  • The proportion of products reimbursed at $600 or more per fill in commercial insurance plans nearly quadrupled between 2003 and 2014.
  • Over the same time period, spending on these drugs nearly tripled, from 11 percent of total prescription medication spending to approximately 43.2 percent.
  • Median out-of-pocket spending increased by 46 percent for specialty drugs and decreased by 57 percent for non-specialty drugs during this time.

In spite of the degree to which specialty medications are driving up health plan spending, “payers are reluctant to aggressively manage spending on them because of their importance to patient health,” researcher Stacie B. Dusetzina of the University of North Carolina Chapel Hill noted in the study. 

"This may be a foreshadowing for what's next," Dusetzina tells the Associated Press. "There's a lot of new, very-high-priced treatments that are getting ready to emerge on the market, which would really increase spending."

The UNC study found the three most expensive prescription drugs for commercial health insurers in 2014 were the rheumatoid arthritis drugs Humira and Enbrel and the hepatitis C drug Sovaldi, with the highest reimbursement per fill of $28,083.

Along similar lines, a recent Bloomberg analysis found that prices increased by more than double the rate of inflation between 2009 and 2015 for three out of four medicines with $1 billion or more in global annual sales, even when discounts negotiated by insurers and pharmacy benefit managers were factored in.

Dusetzina says payers could likely reduce specialty drug spending by relying on generics and implementing value-based payments for high-priced medications for which outcomes vary.

- here’s the study abstract
- read the AP article