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Employers Challenged by Expensive and Time-Consuming Specialty Drugs, According to Benefits Quarterly Magazine
[July 17, 2017]

Employers Challenged by Expensive and Time-Consuming Specialty Drugs, According to Benefits Quarterly Magazine


Ninety percent of large employers said they found the cost of new specialty drugs to be challenging and the drugs accounted for one-third of the time they spent on managing employee health benefits, according to a published survey in the second quarter 2017 edition of Benefits Quarterly.

The 2016 survey, developed by Anthem, Inc. and C + R Research, included benefit decision-makers from 303 employers in 14 states with more than 100 full-time employees. Forty-one percent of the respondents were Anthem customers and 38 percent of the employers self-insured their health insurance.

In 1990, there were 10 injectable specialty drugs on the market which grew to 300 by 2015, according to the American Journal of Managed Care. A chronic condition that will continue over an employee's lifetime can generate a drug treatment cost of more than $100,000 annually.

Specialty pharmacy drugs are high-cost, high-touch medication therapies for patients with complex disease states, such as cancer and multiple sclerosis, which can be life-changing. Typically, these drugs are dispensed by specialty pharmacies and include oral, injected and infused biological products.

"We realize how difficult i has been for employers to provide the breadth of benefits they want their employees to have, yet keep their premiums affordable," said Michael Napolitano, vice president of accounts for Anthem pharmacy. "The purpose of conducting the survey was to get to the heart of these issues and determine how insurers can better help employers provide their employees with benefits that provide access to quality care and still be affordable."

Other results included:

  • 77 percent said they were somewhat to very challenged in being able to understand the complete picture of de-identified specialty drug claims associated with the medical diagnosis.
  • 80 percent of employers said they were somewhat to very challenged by the trend of infusion for specialty drugs moving from doctor's offices to often costlier outpatient hospital sites.
  • 69 percent said formulary management was somewhat to a very important tool in managing specialty drugs.
  • 31 percent used programs with provider incentives to use treatment pathways.

"Employers were so varied in the type of plan programs they were using to help manage specialty drugs," said Napolitano. "It was interesting to see the high percentage of employers who found getting accurate, consistent measurement of specialty drug expenditures under both benefits to be challenging. As a company offering integrated pharmacy and medical benefits, we know those concerns can be overcome."


Fifty-six percent surveyed said they were going to seek additional education on specialty drugs. Insurers can assist employers in understanding and using techniques, such as integrated benefit specialty management, managing infusion site of care, and specialty drug pathways, among other strategies.

About Anthem, Inc.

Anthem is working to transform health care with trusted and caring solutions. Our health plan companies deliver quality products and services that give their members access to the care they need. With over 74 million people served by its affiliated companies, including more than 40 million within its family of health plans, Anthem is one of the nation's leading health benefits companies. For more information about Anthem's family of companies, please visit www.antheminc.com/companies.


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