As we’ve previously discussed, reducing the cost of specialty drugs is becoming a hot topic. Specialty drugs are rapidly becoming one of the biggest parts of health plans in the United States today and cost reduction is the biggest issue. They make up more than half of all prescription costs, and that number has only risen in recent years. 

These specialty drugs have also had a huge impact in health. They can be used to treat conditions that previously had no medicinal treatment, and they can dramatically improve both longevity and quality of life. However, when your health lies in balance, the most crucial consideration is whether the benefits outweigh the risks.

We need to find a way to take full advantage of the medical benefits of these new treatments while keeping their costs under control for both the individuals who need these drugs to survive and our healthcare system as a whole. 

Why Should We Care About Reducing the Cost of Specialty Drugs? 

Specialty drugs often provide the only glimmer of hope for individuals with severe medical conditions. By participating in efforts to reduce their cost, you’re helping create a more equitable healthcare environment. 

Even if you don’t need a specialty drug now, you or a loved one might need one in the future. It’s in everyone’s interest to ensure that these drugs are affordable, effective, and available. Fortunately, there are things that all of us, including both patients and providers, can do! 

How Can I Be Sure I Have the Right Specialty Drug? 

We all know that specialty drugs can be expensive. When that medication is saving your life or making a significant improvement in our health and lifestyle, we are more accepting of that cost. But even the most advanced pharmaceuticals don’t bat 1.000. 

Not everyone responds to medications the same way, so a drug may simply not work for a particular person. There may be significant side effects identified by you or medical care that outweigh the benefits of the medication. The drug may interact with other medications and/or conditions in unexpected ways. 

Whatever the reason, we need to be sure that people are taking the right medications that have the most positive impact on their conditions. 

But sometimes you won’t know if a medication is the right one until you’ve tried it. One strategy for addressing this is reducing wastage. That means lowering the chances that someone will get a large, expensive prescription that they ultimately find they are unable to take.  

A solution here can be partial fill programs. For example, when someone is looking at starting a new specialty drug, we may start with just a two-week supply instead of immediately filling 30, 60, or even 90 days worth of medication. If the patient is responding well to the medication after the first week, then they’d fill the remainder of the month’s prescription.  

Another exciting development in recent years could make it even easier to make sure people are getting the precise medication they need: genetic mapping and disease specific testing. 

With any medication, there are groups of people who respond well to the drug and there are groups of people who do not respond to the drug. Wouldn’t it be great to know who is who? Sometimes the answers are in our genes. 

New genetic tests help us to know how someone will respond to different types of medications. With that information, we don’t have to waste time starting someone on an ineffective drug – and even more time escalating the dosage to try to get a result before moving on to a different treatment. 

Genetic tests can sometimes tell us if you will see results from specific types of drugs. If we know you’re not a good fit, we can immediately go to the next best option, saving lots of time and money for everyone. This is cost saving and time saving!  

Where Should I Get My Specialty Medication? 

Getting the right specialty drugs is the first step to controlling costs, but another important step is getting those medications from the right place. 

A good way to think about this question is in terms of channel opportunities. There are different types of cost depending on the site of care: are you doing this at a hospital, a private physician’s clinic, a home infusion, etc.? Are there administrative costs? Health insurance coverage? Pocket costs?

Sometimes a hospital outpatient facility might be the highest cost option, because of all the other facilities attached to that hospital. For example, the hospital has to pay for an Emergency Room, specialty wings, and lots of other overhead. 

It might be more affordable to get the exact same treatment and medication at a physician’s clinic. There may be ess overhead, and that can mean less cost for the patient. 

The lowest cost of all in some situations might be a home infusion, when that is available as an option. Understanding the differences in sites of care can make a significant difference over time, when you need to receive treatment month after month, or even week after week. 

If you have options for where you get medication or treatment, it’s worth taking those options seriously, to find the most cost-effective way to go. 

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When it comes to medication, money isn’t the only thing. But it’s still important, and if we all make informed decisions about these medications, we can keep them more affordable not only for ourselves but for everyone else who needs them, too. That’s part of the prescription for a healthier, more thriving world.