What makes a drug fall into the “specialty” drug category is a combination of several factors. First, they tend to be very expensive. This is because they were recently approved, meaning they are under an active patent with no generic or biosimilar version available. Second, specialty drugs may be more difficult to store, needing constant cooling. The administering of the drug may require a professional. Also, drugs that treat rare or complex diseases tend to fall into this category. In summary, specialty drugs earn the label by having one or more of three big issues: high cost, high touch, or high complexity.
One factor that makes us feel more strongly about medication is its cost. It’s understandable that medications that cost $1000 per 30-day supply feel more serious than one with a $30 copay, especially for someone on a fixed budget, and the medication is life-changing. Some drugs are extremely high cost, like Zokinvy, the drug that treats Hutchinson-Gilford progeria syndrome and costs up to $86,000 per month. Or Rybelsus, a commonly used drug to treat type II diabetes which costs over $1000 per month.
Another factor that makes a drug more “specialty” is how much patient care management is required. This could include any of the following:
- Medications that require member education, compliance monitoring, side effect management, or self-administering injection education.
- Medications that require temperature control, special handling or regulations, or shipping requirements.
- Medications that require drug management by a physician specializing in treating the member’s condition or professionally administered infusions.
Complexity refers to the drug’s formula and typically means the drug is more difficult to produce. These are biology-based, structurally mimicking the body’s natural compounds. A new subclass of highly complex drugs is Orphan or ultra-orphan drugs. These are medications that treat a rare disease or condition that affects fewer than 200,000 people in the United States.
Healthcare technology companies like RazorMetrics are working to bring more options to clients in the specialty drug space. Though changing medication in this category could be less likely than other drugs, RazorMetrics leaves the decision up to the physician and the patient. Just giving the physician and patient another option to consider, RazorMetrics has found that members are very appreciative. Some drugs, like those that treat HIV or cancer, have a strong emotional tie with the client but just because it is emotional doesn’t mean it is a bad thing to weigh the options.
Cost and availability of alternatives of the specialty drug are important factors that neither physician nor patient are aware of. Beyond transparency, RazorMetrics provides alternatives for the prescriber that are medically equivalent but are more affordable for their patient.
As of now, RazorMetrics covers 18 specialty drug classes, with more being added every month, including the following:
- Praluent Repatha
- Humira Pen
Also, where a different drug may not be available, we analyze other forms of the drug and offer alternatives that cost less. For example, changing from pen to injection can save thousands of dollars a year. To get more information on how RazorMetrics can help lower drug costs, please contact us today.
RazorMetrics is a healthcare technology company whose SaaS-based platform uses AI to lower drug spend for health plans, self-insured employers, and consumers. RazorMetrics’ unique, physician-focused approach uses a process that is simple, requires no extra clicks in the electronic health records, and no external programs or apps to download. The platform is complementary to existing pharmacy initiatives and works with PBMs and other drug cost savings solutions to optimize results. RazorMetrics is fully scalable and customizable to each client’s unique variables and formularies. For more information, visit razormetrics.com.