Specialty drugs are typically high dollar medications. Many specialty drugs can be administered in a hospital setting, outpatient setting, and at home, but not all suppliers charge the same. A claimant who obtains the specialty drug from the hospital pharmacy, and not their listed specialty pharmacy, often pays triple the cost. Other times there may be a substitute specialty drug at a lower cost. Drug pricing is not transparent, even to the doctors who prescribe them. It is always important for patients to ask about and research alternative drugs options, which can save a significant amount of money for both the employee and employer.
Recently we had an employee obtain a chronic disease specialty drug through a hospital pharmacy, although it could have been administered in an outpatient setting. The cost through the hospital pharmacy was much higher per dosage than the usual and customary rate. Upon recognizing the higher than normal cost, we outlined for the group the substantial additional annual cost for purchasing this maintenance drug through the hospital.
The solution was shifting to an equally effective drug the claimant could purchase through the PBM’s specialty pharmacy at a less expensive rate per dosage. Not only did our advice lead to an annual savings of approximately $97,400 for the first year, and an anticipated savings of $111,000 for the second year, but the employee realized a better outcome by taking the new specialty drug at home.
Our team is always here to help. Feel free to reach out at hfox@roundstoneinsurance.com, if you have any questions regarding ways to save costs related to specialty drugs.
Heather Fox BSN, RN
Cost Containment Nurse
I am a graduate of Indiana Wesleyan University with a Bachelor of Science in Nursing and have been a Registered Nurse for 16 years. Prior to my employment at Roundstone, I worked on a Critical Care Unit. I also have previous nursing experience on a Medical Surgical Unit, in an Operating Room and as a Float Nurse. I grew up wanting to help people, and being a part of the Cost Containment Team at Roundstone allows me to continue to do this through my work with the underwriting and claim departments.
