Over 25 percent of prescription drug spending in the U.S. was attributable to specialty drug costs in 2013, and specialty drug spending is expected to grow by more than 60 percent by the end of 2015, according to a recent report by HealthPocket.
Here are 10 things to know about specialty drug pricing.
1. Nearly 70 percent of Food and Drug Administration approvals in 2013 were for specialty drugs, according to PwC’s Health Institute’s annual medical cost trend report for 2015.
2. Specialty drug spending is projected to reach $192.2 billion by 2016, a 121 percent increase from the $87.1 billion in 2012, according to PwC’s Health Institute’s annual medical cost trend report for 2015.3. In a survey by the Morning Consult, 60 percent of respondents said they were concerned with the high price of specialty drugs and afraid they would not be able to afford them in the future.
4. The high price tag of some specialty drugs, including Gilead Sciences’ hepatitis C drug Sovaldi, have received Congressional scrutiny.
5. In July, Sens. Ron Wyden (D-Ore.) and Chuck Grassley (R-Iowa) sent a letter to Gilead seeking an explanation for Sovaldi’s $1,000 a pill price.
6. The vast majority of Americans (82 percent) believe charging $1,000 a pill is “unacceptable,” according to the Morning Consult survey.
7. When the four metal categories — bronze, silver, gold, and platinum — were compared, out-of-pocket specialty drug costs for platinum plans were the lowest, according to the HealthPocket report.
8. The out-of-pocket cost for specialty drugs for those with platinum plans was 64 percent lower than those with gold plans, 74 percent lower than those with silver plans, and 78 percent lower than those with bronze plans, according to the HealthPocket report.
9. The average annual out-of-pocket cost for a 30-year-old bronze plan enrollee taking specialty drugs is $9,568.78, while the average cost for a platinum enrollee of the same age is $6,670.70, according to the HealthPocket report.
10. Bronze plans do not always lead to the most out-of-pocket costs for specialty drugs, as there are some bronze plans with lower annual out-of-pocket costs than some silver and gold plans. For example, a 50-year-old bronze plan enrollee taking specialty drugs has average out-of-pocket costs totaling $11,396.44, while the average silver plan enrollee of the same age spends an average of $11,583.55, according to the HealthPocket report.
Written by Ayla Ellison
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