“It illustrates that employers, insurers and patients are really dependent on the reasonableness and good behavior of drug manufacturers in terms of pricing because our patent systems and rules for competition really give them a lot of leeway,” said Steven Wojcik, vice president of public policy at the National Business Group on Health. “It illustrates the issue that is of great concern for employers — the growing expenditures for specialty drugs. It’s not sustainable for plans and it’s not affordable for individuals.”
“They’ve got people in a bind — the insurer, the PBM, the employer and the patient,” Wojcik said. “They don’t have many tools to negotiate.”
Most drug manufacturers offer coupons and rebates, which can help reduce costs in the short-term, but do little to help employers manage costs over the long run, Wojcik said.
Overall pharmacy spend is expected to increase by 7.3 percent in 2017, with specialty drugs accounting for most of that increase, according to a recent report by the NBGH. Spending on specialty pharmaceuticals is expected to increase by 16.8 percent next year. In response, employers are getting more aggressive about managing specialty drug use.
“There is much more aggressive utilization management,” Wojcik said. “Employers are making sure that the medication is purchased by a specialty pharmacy rather than going through a physician’s office, they are adding specialty tiers to their drug formularies, coaching patients on adhering to their medications, making sure the drugs are administered properly, among other strategies.”