In the October 2014 issue of Health Affairs, Editor-in-Chief Alan R. Weil describes how the promising new era of specialty pharmaceuticals—drugs typically used to treat chronic, serious, or life-threatening conditions such as cancer, rheumatoid arthritis, and multiple sclerosis—will renew complex policy debates about the costs of and access to prescription drugs. Often priced much higher than traditional drugs with few if any generic alternatives, these specialty drugs are projected to make up half of all drug spending by 2020.
In his commentary, Weil notes that the growing cost of specialty drugs may push health insurance premium prices so high that pharmacy benefit managers—those who administer prescription drug plans—will be forced to reconsider common, long-standing practices, such as cost-sharing tiers for prescriptions, for keeping overall drug spending down.
Just such changes have been put in place by insurers, and Weil looks at some of the new strategies health plans have introduced to control drug costs and maintain patient access. For example, some insurers have instituted “fail first” policies, in which a lower-cost treatment must be tried without success before they will pay for a more expensive option. This approach has been met with controversy in a number of states.
Finally, Weil highlights two issues central to the policy debate: assessing the benefits of specialty drugs to patients relative to their costs and determining who should pay for them.
Pew’s specialty drugs project works to identify policy options that will help manage these drug costs and ensure patients receive treatments they need.
Read the full article.