The most expensive drugs are “specialty drugs,” but no one has defined exactly what they are. They are generally the drugs that fit into one or more of the following categories: 1. the manufacturer put a high price tag on the drug; 2. the drug treats a complex, chronic, or rare condition; and /or 3. The drug requires special handling, storage, or administration. There is no doubt these types of drugs are in high demand because they deliver life-saving and life-enhancing treatments for many people. At the 2024 AMCP Nexus conference, a major topic was specialty pharmaceuticals—ranging from gene therapies to biosimilars—as a major driver behind both medical and pharmacy costs. The question for many health plans and employers is, how do we ensure access to these high-value treatments and keep total healthcare costs affordable?

High-Value Therapies

Innovative treatments for painful conditions such as autoimmune diseases, hemophilia, and Alzheimer’s are developing quickly, but the steep prices could put the treatments out of reach. Most people cannot afford a treatment that costs in the hundreds of thousands to millions of dollars per year. Here are a few examples:

1. Glepaglutide: Treats short bowel syndrome to improve nutrient absorption and enhance intestinal function. Expected annual cost between $500,000 and $750,000.
2. Sebetralstat: Treats hereditary angioedema by reducing or preventing the sudden and painful swelling that can be life-threatening. Expected annual cost $200,000 to $300,000.
3. Fitusiran: Treats hemophilia A or B by targeting a specific protein involved in blood clotting regulation. Expected annual cost $500,000 to $750,000.
4. Mozafancogene autotemcel: A gene therapy for Fanconi anemia, with potential costs of $2 million to $3 million. This therapy involves collecting a patient’s hematopoietic stem and progenitor cells (HSPCs) and then genetically modifying them with a functional copy of the gene. The corrected cells are infused back into the patient, aiming to restore normal blood cell production and mitigate the effects of bone marrow failure.
5. Valiltramiprosate: Treats Alzheimer’s disease by inhibiting the formation of neurotoxic amyloid-beta (Aβ) oligomers. Expected annual cost $20,000 to $50,000.
6. Olezarsen: Treats familial chylomicronemia syndrome by flushing more triglyceride-rich lipoproteins from the bloodstream and reducing the risk of pancreatitis and cardiovascular. Expected annual cost $300,000 and $500,000.

There is little doubt that the above drugs will dramatically improve the lives of millions of people, if they can afford the treatments. The cost burden on self-funded employers and health plans is totally unsustainable without help to contain these high pharmacy costs.

HealthTech Helps Control Specialty Drug Costs

RazorMetrics is obsessed with controlling the rising cost of specialty drugs. By leveraging data, RazorMetrics helps employers, health plans, and benefits administrators navigate the specialty drug quagmire while making sure that employees and members retain access to the care they need.

Here’s how we do it:

Pharmacy Optimization: RazorMetrics’ platform uses advanced analytics to ensure that specialty drugs are aligned with clinical guidelines. By identifying opportunities to switch to clinically equivalent but lower-cost alternatives, RazorMetrics reduces unnecessary spending while maintaining high-quality care.

Biosimilar Adoption Strategies: With our innovative Biosimilar Interchange program, we can immediately affect a formulary change of an entire membership base to a lower cost biosimilar. Using this program, we have saved customers millions of dollars without compromising treatment efficacy.

Polypharmacy Management: Many patients requiring specialty drugs tend to be on multiple prescriptions. RazorMetrics’ polypharmacy management solution contacts these patients’ physicians to ensure a full medication reconciliation is conducted to optimize treatment regimens, reduce the risk of adverse drug interactions, and deprescribe unneeded medications.

Future-Proofing the Specialty Explosion

The specialty pharmaceutical pipeline is impressive in both groundbreaking technology and cost, employers and health plans must remain proactive. The jaw-dropping projected costs can be managed with the pipeline for new biosimilars and other effective cost-containment strategies.

RazorMetrics is uniquely positioned to help organizations navigate these challenges with our physician-first approach, biosimilar interchange, polypharmacy management, and growing innovations. RazorMetrics helps organizations stay ahead of the specialty drug cost curve—delivering better care at a lower cost.