Shifting the Focus on Specialty Medications

PrescriptionDrugsAcquisition cost, not clinical value, is typically the driving force behind consumer cost-sharing provisions for specialty medications in nearly all public and private health plans, according to a report by the University of Michigan Center for Value-Based Insurance Design (V-BID Center) and the National Pharmaceutical Council (NPC). Specialty medications, which typically require special handling, are used frequently in the treatment of cancer, rheumatoid arthritis, multiple sclerosis, and many other serious and often life-threatening conditions.

The increased trend of prescribing this class of medications coincides with a recent trend among public and private payers to shift a larger portion of the medication costs to consumers. “It is imperative for decision-makers that cost-containment efforts don’t produce preventable reductions in quality of care,” said report author and V-BID Center Director, A. Mark Fendrick, MD.  As Americans are responsible for an increasing portion of the cost of medical care, cost-related non-adherence of potentially life-saving interventions is a real and growing problem. Replacing the archaic cost-driven approach to consumer cost-sharing with clinically nuanced alternatives can improve quality, foster consumer engagement and mitigate legitimate concerns that one-size-fits-all strategies may lead people to forgo important care, according to the report. For more information,

Last Updated 08/10/2022

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