How Do You Curb Specialty Drug Spend? – Apex Benefits

How Do You Curb Specialty Drug Spend?

Pile of pills spilling out onto an invoice sheet

Pile of pills spilling out onto an invoice sheet

Pile of pills spilling out onto an invoice sheet

Drugs can become “specialty drugs” because of the way they are manufactured, distributed, or treat rare disorders, among other reasons.

Specialty drugs are expensive, and they can quickly wreck a pharmacy benefit budget, too. Just one specialty drug could cost 85 percent or more of a plan’s total spend on pharmacy and drugs for the year. Also, as mentioned in a recent Apex blog, “many of the new drug approvals in 2020 were for specialty drugs, and the prices are eye-opening.”

One way to curb soaring specialty drug prices is having the patient go straight to the manufacturer for any eligible discounts on specialty drugs. Many drug manufacturers offer patient assistance programs (PAPs). PAPs can generally come in two forms for specialty drugs:

  1. Copay assistance
  2. Financial-based assistance.

Both of these programs can help curb the high cost of specialty drugs.

The best place to check if a specialty drug has any possible PAPs is a site called Needy Meds. Site visitors can easily search by drug name to check what type of patient assistance programs are offered for the drugs.

At Apex, we can also help curb specialty drug spend in self-funded plans. If you have a self-funded pharmacy benefit plan, but you’re not sure if your plan maximizes patient assistance programs, contact us and we can help you curb specialty drug spend moving forward.

Read more Apex blogs here.

Erin Albert

Erin Albert, PharmD

Pharmacy Benefit Practice Leader

Erin is a clinical pharmacist and pharmacy educator. She also is an attorney, writer, preceptor, podcaster, and STEM advocate who helps break down the complexities of healthcare. Before joining Apex in 2020, her career spanned across healthcare, pharmacy and law – inside a wide variety of settings for over two decades, including teaching at Butler University College of Pharmacy and Health Sciences for over a decade. Connect with Erin. 

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