How to manage Specialty drug costs

In 2020, specialty drugs accounted for 50% of national prescription costs while constituting only 2% of prescription volume. 

With the average price of a specialty medication costing approximately $4,000 per month, it is the most important topic impacting self-funded employers.

Below are three key ways the Sona team is managing clients’ specialty drug costs:

1.   Smart Rx Plan Design

Designing an Rx plan that incentivizes members to utilize a therapeutically equivalent generic or brand medication, in place of a specialty drug, is the first step in managing these costs.

The Sona team custom designs each client’s plan to ensure that members have access to specialty medications when needed, but are incentivized to utilize therapeutic alternatives where possible.

2.  Experts are Involved Early

If a specialty medication is prescribed, the experts are on it.

Clinical pharmacists are the most qualified individuals to review the necessity of specialty medication. They have advanced medication training and should be involved in every specialty decision, not only for potential savings but for member health.

For this reason, a Sona Benefits Clinical Pharmacist reviews each specialty prior to authorization to ensure it is necessary, effective, and the best therapeutic option.

25% of the time, there is a better therapeutic option for the member and can avoid unnecessary spending.

3.  Utilize Alternate Funding Programs

If a specialty medication is approved through the prior authorization process, the Sona Benefits team utilizes applicable Alternate Funding Programs. 

These programs are offered directly through drug manufacturers to reduce costs while taking care of patients. 

The two most common programs are Manufacturer Copay Assistance and Patient Assistance Programs.

• Manufacturer Copay Assistance programs cover the cost of member copays and can be utilized to maximize plan savings.

• Patient Assistance Programs are unique in that qualifying members can apply and receive specialty medications directly from the drug manufacturer at no cost to them or the plan. These programs have applications and income limitations that the Sona team helps members navigate.

Taking these extra steps reduces our clients’ specialty costs by 20%-60%.

At the same time, we help members receive the most effective medications for their conditions. 

Specialty medications will continue to be an important issue that self-funded employers must face as we move into the future. Sona will always be there for our clients to ensure members are provided for and specialty costs are managed appropriately.

Specialty costs data from our Sona Max program: