PBMI Survey Shows Employers Are Pressed to Make Tough Decisions to Curb Specialty Drug Costs

Plano, TX (GlobeNewswire, March 8, 2017) – Twenty-seven percent of employers are using a high deductible plan with coinsurance as part of their specialty drug benefit, according to the 2017 Trends in Specialty Drug Benefit Report published by the Pharmacy Benefit Management Institute (PBMI). Although this strategy helps to lower insurance premiums, it can come at a price of members not following their prescribed drug therapy regimen due to affordability.  The report, sponsored by Walgreens for the sixth year, was released yesterday at PBMI’s 22nd Annual Drug Benefit Conference and includes responses from 298 employers representing 10 million covered lives.

“As our research shows, the growing use and cost of specialty drugs continues to be of great concern to employers,” says Jane Lutz, Executive Director of PBMI.  “As a result, employers are faced with tough decisions to continue to offer an affordable benefit to their members.”

Summary of Key Findings:

Not surprising, managing specialty drug cost trend remains the number one goal for employers (51%), followed by reducing inappropriate utilization (13%)

The top two specialty-drug related problems employers face are the cost of new specialty treatments and the changes in manufacturer pricing on existing specialty medications. More than 60% of employers are in favor of government controls on manufacturer pricing of specialty medications

Ninety percent of employers are concerned with the impact direct-to-consumer advertising has on patients pressuring physicians to prescribe specific medications

For the first time since the inception of this report, the percentage of employers with coinsurance cost-sharing designs has surpassed those using copayment structures (51% vs. 43%)

In addition to the use of high deductible plans and coinsurance strategies, 54% of employers have implemented formulary exclusions to manage costs for specialty drugs. Fertility, hepatitis C, and inflammatory conditions were the most common specialty drug classes with formulary exclusions

  • However, 53% of employers rate member dissatisfaction as the greatest challenge with formulary exclusions
  • Yet, 38% are considering implementing or increasing the use of exclusions on their formulary

    Ninety-three percent of employers cover hepatitis C medications (83% cover Solvaldi®)

  • Employers are mixed on the future of hepatitis C cost trend (29% say it will decrease; 19% say it will stay the same, and 52% say it will increase)

PBMI will host a free webinar on March 16, 2017 at 1:30 pm Eastern to discuss the results of this report.  Register today. To request a copy of this report, click here.

About PBMI

The Pharmacy Benefit Management Institute provides research and education to help healthcare and benefits professionals work with pharmacy benefit managers to design prescription drug benefit programs. Learn more at www.pbmi.com.  

 Julie Blackman