Specialty drug costs a major employer worry: U.S. survey

Programs to influence healthier behaviour also in focus
By Lewis Krauskopf
|hrreporter.com|Last Updated: 05/24/2012

(Reuters) — Employers in the United States want to step up programs to encourage healthier behaviour among their workers and to control spending on expensive injected specialty medicines, according to a survey by pharmacy benefit manager Express Scripts Holding.

Cost is increasingly a concern as employers formulate their prescription drug plans, according to the survey of more than 300 benefit officials in the U.S.

Five years ago, 57 per cent of respondents said their prevailing philosophy for a pharmacy benefit was "providing the broadest coverage." But now that number has fallen to 14 per cent, while 78 per cent now support "balancing cost with care," up from 41 per cent five years ago.

"The market in a lot of different places has said more choice is not necessarily better," said Tim Wentworth, Express Scripts' president of sales and account management.

The survey by Express Scripts, the largest U.S. manager of pharmacy benefits, also found that 36 per cent of plan managers cited use and cost of specialty medicines as their biggest concern. For employers with more than 25,000 members, 58 per cent named specialty costs as their top worry.

Specialty medicines tend to be injected or infused for conditions such as cancer and rheumatoid arthritis and can cost tens of thousands of dollars per year. Many of the new drugs hitting the market now and expected to do so over the next few years fall into this category.

Specialty drug spending rose 17.1 per cent last year, while overall spending on medicines increased only 2.7 per cent, according to Express Scripts.

Wentworth said such spending tends to make up less than 30 per cent of a client's overall drug spending but "it is the fastest-growing component, and so they want to put things in place now."

For example, the vast majority of survey respondents expected to institute programs that require members try the lowest-cost drug that is appropriate before starting on a new drug — so called step therapy — in the next two years.

More than 75 per cent of plan sponsors say behavior-driven conditions are the greatest contributors to rising health-care costs. So while only 58 per cent say they currently use wellness programs, such as financial incentives to stop smoking or monitor weight, 81 per cent plan to do so in the next two years.

One example of efforts to influence behavior from a pharmacy perspective is plans that lower co-payments for medicines for chronic conditions, such as high cholesterol, to encourage members to stay on their medicines.

"This is a broad acknowledgement of how critical addressing behavior is to reducing healthcare costs," Wentworth said.

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