In today’s complex healthcare environment, we continue to see a dynamic shift in managing complex chronic conditions with life-saving drugs. This introduces additional challenges for employers and their employees, especially in terms of access and affordability.
With the evolution of prescription benefit management, it’s a critical best practice for employers to plan today for tomorrow’s challenges. This will help identify opportunities and strategies to ensure the best clinical and economic outcomes for their company and their employees while delivering high-value, cost-effective prescription benefits.
Now is the time when most employers are planning for 2019 budgets. Understanding what will drive costs creates the opportunity for strategies to ensure the right drug is used for the right patient at the right time.
We are noticing three key themes related to 2019 expected pharmacy costs:
- Overall drug costs will continue to grow by single digits primarily through generic competition and slower growth of specialty drugs. Specialty drugs will continue to drive the overall drug trend, continuing to increase by double digits (around 11%).
- Two conditions: Autoimmune (anti-inflammatory) and Diabetes – account for 30-35% of all pharmacy costs. Drugs used to treat complex chronic conditions such as rheumatoid arthritis, psoriasis, Crohn’s disease, and other autoimmune diseases, along with cancer and HIV/AIDS drugs, will account for about 60% of all specialty drug costs.
- Specialty costs on the medical benefit are the most significant cost drivers today with little management. Injectable and infused drugs administered by providers to address conditions such as cancer and autoimmune disorders present unique challenges, with cancer and cancer-associated supportive drugs having a trend up to 25%; however, with less than 60% of employers having care management and prior-authorization programs for these top conditions.