Roundtable Releases 2019 Specialty Drug Survey

On Tuesday, the Public Sector HealthCare Roundtable released its Annual Specialty Drug Survey in conjunction with our 2nd Annual Congressional Forum.  22 plan sponsors representing 138 health plans completed the survey in 2019. In aggregate, these organizations provide benefit coverage to 6,400,000 lives with a total drug spend of approximately $7.8 billion per year, including $3.7 billion dollars on specialty drugs. 

Other important 2017-2018 trend results are summarized below:   

  • Total drug trend averaged 3.0%  
  • Traditional drug trend averaged -.5%  
  • Only 1% of claims were for specialty drugs  
  • Specialty drug trend averaged 8.7% 
  • Four-year average for Specialty Drug trend was almost 16% annually  

Plan sponsors responding to the survey stated they are attempting to control these daunting cost trends with the following strategies:  

  • 100% of respondents use targeted strategies to control specialty drug costs  
  • 91% of respondents use prior authorization across some or all specialty categories  
  • 77% of respondents use a carve-out specialty distribution capability  
  • 55% use a separate copay or coinsurance tier for specialty medications 

In addition to basic plan and cost control information, the survey collected data on future expectations. In the most recent survey, 68% of respondents are concerned about increased financial hardship on members due to higher cost sharing. 68% of respondents are concerned about corresponding medical complications due to decreases in medication adherence. Finally, 55% of respondents are worried about the uncertainty of their organization’s ability to continue providing a high-quality health and benefits plan to their members.