Grappling with Rising Prescription Drug Costs: How Employers Can Take Control

American pharmaceutical companies are arguably the world’s most inventive, regularly introducing specialty medications for an array of chronic health conditions that are on the rise. But they don’t do it for free, and the costs are becoming more and more difficult for employers to carry.

As of 2020, 6 in 10 adults in the U.S. had a chronic disease.¹ Specialty drugs to treat these conditions now account for over 50% of total prescription drug spending despite being used by only 2.5% of patients.² The good news is that the right pharmacy benefit management partner can dramatically reduce these costs for both employers and employees.

The Specialty Drug Dilemma

Specialty drugs are innovative treatments designed to address complex or chronic conditions such as multiple sclerosis, cancer, and rheumatoid arthritis. While these medications can greatly improve quality of life, they come with a hefty price tag. The average annual cost for a specialty drug is a staggering $84,000,³ more than ten times the cost of regular prescription medications.

The explosive growth in specialty drug costs is putting immense pressure on healthcare budgets, with estimates indicating that specialty drug spending would add up to $311 billion for 2023.⁴ For employers and plan sponsors, this trend poses a significant threat to the sustainability of their pharmacy benefit plans.

Strategies for Plan Sponsors and Benefits Advisors

To shelter employees and clients from the enormous costs of specialty drugs, plan sponsors and benefits advisors should consider the following approaches:

• Utilize Specialty Pharmaceutical Programs: Well-designed specialty drug management programs can help achieve lower costs without compromising care quality.
• Employ Utilization Management Techniques: Strategies such as prior authorization, step therapy, and prescription duration limits can help control costs while ensuring appropriate medication use.
• Leverage Data Analytics: Regularly analyzing drug spending across both medical and pharmacy benefits can inform plan design decisions and identify cost-saving opportunities.

A fiduciary Pharmacy Benefit Manager (PBM) like US-Rx Care can be a game-changer in managing specialty drug costs. Unlike traditional PBMs, fiduciary PBMs are legally obligated to act in the best interest of their clients, ensuring transparency and alignment of incentives. US-Rx Care offers several advantages as a fiduciary PBM:

• Transparent Pricing: Full disclosure of all revenue sources, eliminating hidden fees and conflicts of interest.
• Customized Formularies: Tailored drug lists that balance clinical efficacy with cost-effectiveness.
• Advanced Analytics: Sophisticated data analysis to identify trends and optimization opportunities.
• Clinical Expertise: Access to pharmacists and healthcare professionals for personalized guidance.

Right Rx Services: An Alternative Approach

For organizations not ready to change their PBM, US-Rx Care’s Right Rx services offer an alternative path to cost optimization. These services work alongside existing PBM arrangements to:

• Analyze current drug spending and utilization patterns
• Identify opportunities for cost savings without compromising care
• Implement targeted interventions to optimize prescription drug use
• Provide ongoing monitoring and adjustment of strategies

By engaging Right Rx services, employers can achieve significant cost savings while maintaining their current PBM relationship, offering a flexible approach to pharmacy benefit management. By advocating strictly for your enrollees’ best interests, Right Rx saves an average of $15 – $25 per enrollee per month, with over 30% or greater out-of-pocket savings for non-specialty, specialty, and J-code prescription drugs.

Choose the Solution That Works For, Not Against, Your Plan

As a leader in the fiduciary PBM space, US-Rx Care has the clinical and pharmacy benefit administration expertise necessary to sharply cut the costs of needed prescription drugs. Our full PBM solution is proven to save up to 50% on pharmacy benefit costs in just 12 months for self-insured employers. Alternatively, employers who wish to keep their PBMs can contract out utilization management and prior authorization functions to our clinically-based Right Rx program. Whether your organization is looking for partial or full pharmacy optimization, US-Rx Care has the tools and cost-saving frameworks in place to deliver the savings and plan value your enrollees deserve.

Learn more about US-Rx Care’s pharmacy benefits services to discover which solution is best for your plan, and take control of rising prescription drug costs today.

1. Centers for Disease Control and Prevention, “Chronic Diseases in America.” https://cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm
2. IQVIA Institute for Human Data Science. “The Use of Medicines in the U.S. 2022.”
3. AARP Public Policy Institute. “Trends in Retail Prices of Specialty Prescription Drugs Widely Used by Older Americans: 2006 to 2015.”
4. IQVIA Institute for Human Data Science: “The Global Use of Medicine in 2019 and Outlook to 2023.”