Specialty drugs are essential for treating complex, chronic conditions. However, they’re also relatively expensive, and prices are continually rising.
According to an AARP report, the average specialty drug price is rising more than three times faster than other goods and services. What’s more, specialty drugs accounted for more than half of pharmacy spend in 2020 alone—a trend that’s likely to continue in the months and years to come, especially with 60 percent of the new drugs entering the market in 2022 falling into the specialty category.
For patients who rely on specialty drugs, the ever-rising cost can create barriers to access that result in poor therapy initiation and medication non-adherence. Let’s talk about steps health plans and PBMs can take to improve the affordability of specialty drugs:
Why Improving Affordability of Specialty Drugs Is Essential
High out-of-pocket costs create a financial burden that contributes to poor adherence and prescription abandonment. At least 43 percent of patients on specialty drugs have missed at least one dose due to cost. In fact, difficulty affording specialty drugs was the most cited reason for medication non-adherence.
Failure to adhere to specialty therapies can have significant consequences for patients treating complex, chronic conditions such as rheumatoid arthritis and cancer. Even patients battling cancer abandoned treatment due to high out-of-pocket costs, with one report revealing that 32 percent of patients abandoned their oral oncolytic for financial reasons. When costs rose to $2,000 per fill, the number increased to nearly 50 percent.
For patients like these, poor adherence to specialty drugs can ultimately lead to worsening health conditions, increased doctor and emergency department (ED) visits, prolonged hospitalizations, adverse effects, and eventual mortality.
How Payers Can Improve the Affordability of Specialty Drugs
The number of patients prescribed specialty medications is increasing. With so many of those patients struggling to afford their medications, payers seek ways to improve affordability. Here are a few actions health plans and PBMs can take to help improve the affordability of specialty drugs:
- Identify savings programs for specialty drugs.
There are several savings programs available for patients who struggle to afford specialty drugs. Many charitable organizations, and disease-specific advocacy groups offer specialty drug savings programs to provide patients with affordable access to the medications they need. For example, Accessia Health is a non-profit dedicated to aiding with the cost of medical expenses.
- Determine which patients need support most.
Payers can leverage healthcare artificial intelligence (AI) to identify patients who are prescribed specialty drugs and have a high risk of becoming non-adherent. Better yet, in addition to predicting high-risk patients, AI can also predict how likely it is for individuals to be impacted by a targeted intervention.
- Intervene with personalized patient outreach.
With a better idea of which patients to target and which resources to share with them, payers can use healthcare AI to personalize patient outreach and improve the overall effectiveness of their interventions. Intervention channel, messaging, timing, and cadence can all be custom-tailored to meet each patients’ unique needs and increase the likelihood of influencing a behavior change.
Improving the Affordability of Specialty Drugs with AI
Specialty drug costs may be on the rise, but payers and other healthcare organizations can help improve affordability—and in turn, medication adherence—for patients treating complex, often chronic conditions. Get in touch with AllazoHealth to learn about using AI to optimize patient support programs and improve the affordability of specialty drugs.
About the Author
Dr. Linda Schultz
Dr. Linda Schultz is a results-oriented Healthcare Pharmacy Executive who excels at leading transformational, top-notch, interdisciplinary healthcare teams to create and execute outcomes driven clinical operations and account management initiatives. Dynamic and knowledgeable in all healthcare business segments, most passionately within the complex Medicare, Duals and Medicaid markets, she is an accomplished, creative motivator and driver of innovative quality and cost of care pharmacy interventions. Dr. Schultz is currently VP, Customer Success at AllazoHealth, a cutting-edge, healthcare artificial intelligence company. Prior to her leadership role at Allazo, Linda founded and led RxHorizons, LLC., an international healthcare consulting group. Her expertise stems from over 25 years of experience within the Managed Care industry, with a focus on leading, strategizing, developing and implementing pharmacy benefit management activities within national PBMs and health plans.