Higher Specialty Drug Costs the Truth for Many Consumers
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Higher Specialty Drug Costs the Truth for Many Consumers

If you take specialty medications, you may have noticed that you are spending a lot more out-of-pocket than you used to spend.

Specialty drugs, which are much higher in cost and are used to treat complex and chronic ailments such as multiple sclerosis, hemophilia, cancer, or HIV, are being reclassified under employers health insurance plans. No longer using the co-pay model for medicines, patients are now forced to take on more of the financial responsibility in addition to higher copayments.

Specialty drugs are often higher in price because they must be extracted from living organisms, not chemicals like most traditional drugs. Since they must be extracted from living organisms, no alternatives can be used.

Since costs often exceed about $1,200 per month per employee, employer health plans are finding it more expensive to offer these drugs under coverage, according to researchers at the Center for Studying Health System Change.

While specialty drugs are prescribed for 1% of all health plan enrollees, they account for upwards of 16% of drug spending. The costs are expected to continue rising.

Many employers have adopted the "value-based insurance design" (VBID), providing employees with monetary incentives to select high-value health treatments while at the same time turning down treatments that have a history of being ineffective or over prescribed. Many employers believe the same policy can be applied to expensive specialty drugs. Critics, however, feel the employers should not be regulating the types of medications its workers are allowed to use under these plans. Critics point out that many of the VBID treatments still come with high co-pays and high coinsurance. The end result is that consumers are typically paying more out-of-pocket for their co-pays, coinsurance, and prescriptions.

Meantime, consumers needing specialty drugs and having serious ailments will not be able to quibble over which drugs they can use. They will still be forced to use the same drugs while paying higher dollar amounts out-of-pocket.