When you have a chronic or difficult health condition, like multiple sclerosis or rheumatoid arthritis, your physician may prescribe drugs that require special handling, administration or monitoring. It’s also more likely you will need prior authorization (PA) to order. You may also have to order them through a specialty pharmacy and, in a limited quantity.
America’s Health Insurance Plans (AHIP) statistics show that in 2012, specialty drugs accounted for just 1% of prescriptions written but 25% of total drug expenditures. Perhaps even more stunning, health insurer CIGNA reports that 24% of their total health care costs are driven by the 4% of customers who take a specialty medication.
Our payers – health insurers, Medicare & Medicaid – are going to have to strike a balance between providing affordable coverage for everyone and limiting access to life saving drugs that cost $10,000 a dose.
Consumers caught in the middle need to be informed, understanding of the dilemma . . . and patient!
P.S. We’ll be an exhibitor at the BizExpo May 20th at the Potawatomi Hotel & Casino Events Center. Come see us at Booth 411. We can talk about specialty drugs and any other health care issues of interest to you. For more information, click here.