The Cost of Care: The High Cost of Specialty Rx

Written by: Brady Drake

Chronic care’s high-cost factor

Despite their ability to treat complex chronic conditions, specialty drugs come with a high cost that will impact spending trends. To reduce these costs for their employees and ensure access to life-changing medications, employers, and their health plan must work collaboratively and proactively to implement cost management strategies.

Specialty drugs are innovative treatments that promote a better standard of living and prevent further health decline. There are certain chronic conditions, such as autoimmune conditions, cancers, and multiple sclerosis, that require these breakthrough medications for treatment. Special handling and monitoring is necessary for these cutting-edge treatments, which has caused them to have a large price impact in relation to the number of members using them. While specialty drugs only represent 1% of all prescriptions, they account for 60% of Blue Cross Blue Shield of North Dakota’s pharmacy spend.

Top specialty medication needs for our members:

Autoimmune conditions
Multiple sclerosis

Reducing the high cost of specialty drugs

Blue Cross Blue Shield of North Dakota (BCBSND) takes a comprehensive approach to managing our members’ total cost of care that helps keep specialty drugs as accessible as possible:

  • Championing holistic, proactive health care that reduces the impact of complex, chronic conditions
  • Closely monitoring medical and pharmacy data to ensure the best outcomes for members
  • Disrupting the pharmacy supply chain, via innovative partnerships and investments with Prime Therapeutics, LLC., such as HighTouchRx® and IntegratedRx
  • Maximizing pharmacy interventions for emerging life-changing specialty drugs, such as cell and gene therapies
  • Managing prescription drug spend and quality of care through utilization management

BCBSND uses these strategies together to mitigate high costs and keep specialty medication prices manageable for our members.

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Brady is the Editorial Director at Spotlight Media in Fargo, ND.