In a 2018 survey of large employers, 80% identified SpRx costs as a top 3 driver of healthcare costs, and 26% said it was their greatest healthcare cost driver, up substantially from 6% in 2014. Needless to say, employers are concerned about the rapid growth of specialty pharmaceutical (SpRx) expenditures. 

Employers have acted to constrain SpRx expenditures. Those offering high-deductible health plans (HDHPs) have combined medical and pharmacy plan deductibles into one, thereby shifting initial payment for prescriptions to enrollees until they reach the deductible limit. 

Some employers have added pharmacy benefit management features, including utilization management, use of a SpRx vendor, and the addition of a SpRx tier in formularies. Others have excluded many SpRx products from medical plan coverage, thereby shifting greater oversight of SpRx use to pharmacy benefits.

Takeaway Points

Pharmacy benefit managers are offering co-pay accumulator adjustment programs (CAAPs) to counter pharmaceutical company co-pay assistance subsidies for enrollees receiving specialty medications, although the impact of these programs on medication adherence is unknown.

• In this analysis, implementation of a CAAP was associated with significant reductions in autoimmune specialty drug adherence.
• Risk of treatment discontinuation was significantly higher following CAAP implementation.
• Use of specialty drugs included on the preventive drug list, which eliminates co-payments, was not affected by the CAAP.
• Further analysis is needed to evaluate the implications for subsequent healthcare utilization and costs.