Managing Total Cost of Care is a Top Goal but Access to Reliable Data is Challenging, the Latest Trends in Specialty Drug Benefits Report by Pharmaceutical Strategies Group (PSG) Found

Pharmaceutical Strategies Group ("PSG"), an EPIC company, released its annual Trends in Specialty Drug Benefits Report, co-sponsored by Genentech, a member of the Roche Group, detailing the complexities of specialty drug access and affordability. The proprietary research spotlights how employers and health plans are navigating the increasingly complex landscape of specialty drug access for patients.

The research delves into critical issues impacting access to and affordability of specialty medications. Advancements in drug therapies allow patients with conditions treated by specialty drugs to live longer and have improved quality of life. More specialty medications for a broader range of disease states are now available, contributing to a double-digit specialty trend for many payers. Meanwhile, cost savings opportunities such as biosimilars and medical drug rebates have not yet fully materialized as hoped. The dynamics of these opportunities and challenges are key focuses of the report as healthcare payers grapple with managing costs and utilization.

"This year's report made it clear that healthcare plans are zeroing in on managing the total cost of care. Medications aren't just expenses, they're investments that help bring down patient costs in the long run," said Rebekah Gregg, COO of PSG. "With the significant growth in specialty drug development and the emergence of high-cost therapies for more prevalent diseases, the emphasis on managing specialty drug costs continues to be a focal point. It reflects a complex challenge facing the healthcare industry today, navigating the balance between controlling costs and embracing innovative treatments."

The report provides a detailed view of the dual challenge of controlling overall healthcare costs while accommodating the rise of expensive specialty medications. It equips stakeholders with the factual insights needed for informed decision-making to continue to manage specialty drug costs.

"Cell and gene therapies present a striking example of the complexity of the specialty drug landscape," said Morgan Lee, PhD, MPH, CPH, Senior Director, Research and Strategy at PSG, who was the lead researcher on the report. "These groundbreaking therapies have the potential to be life-changing for patients, but their multi-million dollar price tags are a heavy burden for payers. Most survey respondents anticipate gene therapy affordability will be a challenge for their organization in the coming years, yet many plans have not implemented strategies to manage their financial risk."

Key findings from the report include:

• Ninety-three percent of those surveyed receive specialty drug rebates under the pharmacy benefit. Receipt of rebates under the medical benefit rose from 39% last year to 44% in this year's survey, reflecting plans' efforts to manage the financial impact of specialty drugs.
• Thirty-five percent of all respondents cover a Humira biosimilar in a preferred position, and 38% intend to do so.
• Seventy-four percent anticipate gene therapy affordability will be a moderate or major challenge for their organization over the next 2 to 3 years.
• Top concerns are access to reliable data on the total cost of care impact of medications, followed by the affordability of specialty drug cost-sharing amounts for members.

Additional topics covered in the report include the use of a lowest net cost strategy for biosimilars, a look at product adoption for cell and gene therapy financial risk, use of alternative funding models, and participation in value-based contracting.

Download the Trends in Specialty Drug Benefits Report and register for the webinar here.

About the Trends in Specialty Drug Benefits Report
PSG has been researching and reporting on drug benefit design for over 25 years. This year's Trends in Specialty Drug Benefits Report is in its eleventh year of publication and takes an in-depth look at trends and best practices in specialty drug benefit design. It is based on results from an annual survey of individuals representing employers, health plans, and unions/Taft-Hartley plans. PSG fielded this comprehensive survey in September and October of 2023.

About Pharmaceutical Strategies Group (PSG)
Pharmaceutical Strategies Group, an EPIC company, relentlessly advocates for clients as they navigate complex and ever-changing drug cost management challenges. PSG functions as a strategic partner through industry-leading intelligence and technologies to realize billions of dollars in drug cost savings for clients every year. www.psgconsults.com