PBMI Report Shows 71% of Employers Doubtful About Orphan Drug Cost Sustainability

PLANO, Texas, March 08, 2018 -- Orphan drugs provide hope to patients but carry a hefty price tag for members and plan sponsors.  According to the Pharmacy Benefit Management Institute’s (PBMI’s) 2018 Trends in Specialty Drug Benefit report, 71% of surveyed employers feel that covering the cost of expensive medications is unsustainable. The report, sponsored by Walgreens and AllianceRx Walgreens Prime, was released this week at PBMI’s 23^rd Annual National Drug Benefit Conference in Palm Springs, California.  Based on responses from 299 employers representing 15.9 million lives, this report provides information about employer decisions around managing their specialty drug benefits.

“While many employers have programs in place to focus on managing specialty drug costs, there’s clearly a need for more,” says Jane Lutz, Executive Director of PBMI.  “The pipeline is full, and the costs continue to rise. In 2016, the average cost of drugs per patient using specialty drugs was $140,000.”

Joel Wright, Chief Executive Officer at AllianceRx Walgreens Prime, agrees.

“We’re seeing heightened interest from all parties – patients, payers, and providers – wanting to know how they can better manage specialty medications to control costs and maximize effectiveness of therapy,” says Joel Wright. “The science behind the advances in therapy in the orphan drugs class is truly remarkable; however, with a small population needing treatment, manufacturers are challenged to both make the cost bearable to patients and payers and recoup their investment. All parts of the system must continue to work in a coordinated fashion to help patients take the most appropriate drug, at the proper dose and duration of therapy, and then tightly manage side effects and adherence."

Orphan drugs treat rare diseases such as Gaucher’s disease, cystic fibrosis, and Duchenne muscular dystrophy.  Most of these diseases require ongoing treatment, and it’s not surprising that 80% of employers are concerned with drug costs. In addition, almost half of employers surveyed are also concerned about member cost-sharing/affordability (43%) and drug utilization for non-orphan diseases (41%).

The cost of specialty medications remains the primary concern of drug benefit decision makers. With specialty medications expected to reach almost 50% of total drug spend by 2020, employers must find the right balance of strategies to ensure both cost sustainability and patient access for their drug benefits. Surveyed employers cite reauthorization on prior authorization programs (84%), coinsurance (58%); and formulary exclusions (58%), and high deductible health plans (33%) as programs they’ve implemented to help manage appropriate utilization and control costs.

For more details on the results of the survey, download the report here.

A free webinar to review the report is scheduled for March 21, 2018 at 2:00 pm EST. Register today.

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. 

Contact:

Julie Blackman
PBMI
480-730-0814
[email protected]