'It really is frightening': Health plans brace as specialty drugs hit 50% of prescription spending

Payers and pharmacy benefit managers say specialty drugs now account for 50 percent or more of the total prescription spending they manage, Forbes reported May 3. 

"It really is frightening for our clients," CVS Health Senior Vice President of Pharmacy Benefit Management and Specialty Product Development Lucille Accetta said at the Asembia Specialty Pharmacy Summit in Las Vegas, according to Forbes. "We have to be the best purchaser for our clients."

Speciality drugs derived from biotechnology may account for 1 or 2 percent of the claims health plans process for a client, but they are becoming a more significant part of what they have to administer and manage, according to the report. 

Rina Shah, PharmD, Walgreens' vice president of pharmacy operations and services, said health plans and pharmacies are more closely monitoring patients as soon as they are on these drugs to reduce costs of prescriptions while maintaining access to treatments.  

OptumRx Senior Vice President and Chief Pharmacy Officer Michael Einodshofer said health plans are working with clients on options to cover specialty drugs as well as the gene therapies that will be increasingly prescribed in the future, according to the report. 

 

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