Despite only representing 2% of prescriptions, specialty medicines account for more than half of total pharmacy spend, driven largely by biologic medicines for inflammatory conditions and new treatments for cancer and rare diseases. These specialty medicines, while life-saving and life-changing, can also be financially devastating.
According to new research from AHIP, the cost to patients and their health plans is particularly high when these drugs are administered to patients in a hospital setting. The key finding in the AHIP research: Specialty pharmacies are the more affordable option.
What is a specialty pharmacy and how is it different from a regular pharmacy?
A specialty pharmacy is designed to handle, store, and administer specialty medications for people living with rare or complex health conditions. Unlike traditional pharmacies, specialty pharmacies are much more involved in a patient’s care, working closely with the medical team, helping patients use their meds correctly and manage side effects, and more.
"Specialty medications are very expensive drugs. It’s important to find ways to reduce those costs. That’s what’s really amazing about specialty pharmacies; it is their incentive to get the drug at the lowest cost, whereas hospitals and physicians’ offices aren’t necessarily sensitive to price when acquiring these drugs because they’re getting fully reimbursed for the cost of the drug."Sergio Santiviago, vice president of drug policy and federal programs at AHIP
"On top of that there’s a professional service cost for administering the drug to the patient," Santiviago added. "The more expensive the drug, the higher their servicing costs are.”
According to AHIP, the costs per single treatment for specialty drugs administered in hospitals were an average of $7,000 more than those dispensed through specialty pharmacies. Drugs administered in physician offices were an average of $1,400 higher. That means that hospitals, on average, charged double the prices for the exact same drugs, compared to specialty pharmacies, while prices were 22% higher in physicians’ offices for the exact same drugs, on average.
Image source: AHIP
Specialty pharmacies help improve health care affordability while also protecting patient safety, and according to AHIP, it is critical that patients’ lower-cost choices be protected.
"At Cigna, we believe that access to high-quality care is the right of every American,” said Matt Totterdale, president of integrated pharmacy management at Cigna. “We are committed to removing barriers to care and making care more affordable is core to our mission to improve the health, well-being, and peace of mind of those we serve. Healthy Americans equate to improved outcomes for everyone – individuals, communities, businesses, our economy and society as a whole."
Accredo, a specialty pharmacy that serves Cigna customers and other health plan customers across the country, supports patients with complex and chronic health conditions, including cancer, hepatitis C, HIV, bleeding disorders and multiple sclerosis. Accredo’s specialty-trained pharmacists and infusion nurses understand the complexity of these conditions and treatments, and are available 24/7 to provide personalized care to patients. Through Accredo’s 15 condition-specific Therapeutic Resource Centers (TRC), the pharmacy delivers a level of expertise and care that is unmatched, at a lower cost than most hospitals. In 2021, Accredo helped customers connect with $1.7 billion in financial assistance, making critical specialty medications more accessible to patients.
"Patients with complex conditions and their caregivers need the holistic care approach a specialty pharmacy can provide,” said Matt Perlberg, president of Evernorth's Pharmacy business. “This care includes not only the expertise of pharmacists, but also nurses who can administer medications right in the patients’ homes, social workers, nutritionists, and benefit specialists who can proactively reach out to patients to support them through the process."
Let Us Tell You a Little Bit About Accredo
We are a specialty pharmacy. Specialty-trained pharmacists, nurses, and a whole team of passionate people are here to give patients the personalized care and guidance they need to manage their therapy.