Specialty Drug Costs Are Through the Roof, But There Are Proven Mitigating Strategies
Smart RxAssist Is An Innovative, Flexible Approach To Reducing The Cost Of Specialty Pharmacy For Self Insured Plans And Their Members
by Martino Luu, RPh – Executive Vice President of HealthSmartRx Solutions
The rising costs of specialty drugs are no longer just a concern. This has now become an obstacle for many Americans in their ability to receive proper healthcare. Sadly, these enormous price tags are placing many medications out of reach for some people who are forced to choose between their medications and other essentials. According to AARP, the average specialty drug price reached $84,442 in 2020, and the costs are rising more than three times faster than the prices of other goods and services.
Looking ahead, the specialty drug cost trend is not expected to slow. In fact, according to a trend analysis for commercial payers, the specialty drug trend is over 10% The growth rate is driven by the expected approval of new drug therapies and ongoing price increases from pharmaceutical manufacturers
For several years now, we have assisted members with accessing the financial assistance programs offered by drug companies for specialty drug treatments as part of our overall high-cost drug management program. Recognizing that these costs were rising rapidly, creating pressure on our members’ well-being, we looked for new ways to drive down the cost of prescription benefits. Being a self-insured company ourselves, HealthSmart felt the impact of these rising drugs, so we felt the need ourselves to find answers that produced results.
Due to the administrative process of these therapies, a significant portion of specialty drug costs are charged against the medical benefit rather than the pharmacy benefit. We also found out that these copayment assistance programs are not as widely utilized compared to the pharmacy benefit even though the funding is equal or greater than the drugs on the pharmacy benefit. Because of HealthSmart’s expertise in medical claims administration, often working with members who have been diagnosed with rare, chronic and severe medical conditions, we identified an opportunity to bridge this disconnect. So we created Smart RxAssist, an innovative program that works for self-insured commercial plan sponsors, offering significant savings for plan sponsors and plan members alike.
We implemented Smart RxAssist with our HSRx clients, and with some of our existing medical benefits administration clients in 2020. The results were nearly immediate and significant, as we saved substantial dollars in both pharmacy and medical specialty drug costs.
Our clients are now seeing the benefits of this program. For example, last year a consultant was working with a
small hospital’s self-insured health plan who was experiencing rising medical specialty drug costs. The consulted contacted us and asked if we could help. We went to work evaluating their medical specialty drug claims, and found we were able to immediately save the client $25,000 on just nine claims in six months. For a self-insured plan of this size, savings like this can make a world of difference to their overall health plan costs.
Following this success, we worked with a much larger self-insured plan with 230,000 covered lives for a public sector group in the southeast. The results so far have been nothing short of outstanding. Under the Smart RxAssist program, we’re projecting annual savings of $13-14 million for the plan. What’s important to note is how a small number of claims can wreak havoc on a plan’s costs. In this example, the impacted claims were from members representing less than one percent of the plan’s member population.
One thing is clear: the rising costs of specialty drugs are not slowing down any time soon. Smart RxAssist is just one more way HealthSmart is focused on reducing healthcare costs for plan sponsors and while treating members with dignity and respect.
To learn more about Smart RxAssist, visit
www.healthsmart.com/SmartRxAssist. Be sure to
watch a recording of our recent webinar for more details. Contact us directly at
sales@healthsmart.com.
About the Author
Martino Luu, RPh is Executive Vice President of HealthSmartRx Solutions and responsible for managing pharmacy benefit solutions for HealthSmartRx Solutions. Martino has more than 15 years' executive leadership, which includes senior positions Diplomat Specialty Pharmacy, the nation’s largest independent specialty pharmacy, and Medco Health Solutions, formerly the nation’s largest prescription benefits management firm. Martino holds pharmacy licenses in New Jersey, Texas, Tennessee and Florida. He graduated from pharmacy school at Rutgers University and completed his MBA in Entrepreneurship at Fairleigh Dickinson University’s Silberman School of Business.