AHIP Calls for Affordable Drugs

It’s no surprise that health care premiums have been rising steadily for years. For an average family, the annual premium has reached $18,142, according to the National Conference of State Legislatures. A big part of the rise in premiums is due to specialty drug costs. Medications account for more than 22 percent of every premium dollar, outpacing physician, inpatient and outpatient services.

Growth of specialty pharma

Specialty drugs have been taking the market by storm since their introduction in the early 1990s. One of the first specialty pharmaceutical companies, Stadtlanders Pharmacy, focused on a few chronic conditions and charged higher prices, which delivered better revenue than the model of traditional drugstores. Stadtlanders expanded quickly, as did the specialty pharmaceutical market as a whole, with large, national pharmaceutical companies taking over the market.

Prices for these specialty drugs also increased quickly. For example, a drug for multiple sclerosis costed an equivalent of $12,951 (in 2013 dollars) when it was introduced in 1996. In 2013, the price tag increased by almost 400% to $62,394. At over $100,000 annually for some specialty drug regimens, employers and insurers can’t ignore specialty drugs any longer. Though less than 5 percent of Americans need them, they account for almost 40 percent of total drug expenditures.

Addressing the issue

AHIP President and CEO Marilyn Tavenner said in a recent statement, “This is the latest evidence that shows prescription drug costs are out of control. That’s why we need real solutions that answer the president’s call to ‘bring down the artificially high price of drugs’ so that consumers can affordably get the care they need.”

In the wake of rising prices, it is paramount that patients have the correct diagnosis and treatment plan. While the task of reining in drug costs will require regulation by Congress and system-wide measures, the issue of waste in the health care system is also exacerbating the issue. $800 billion is wasted each year, nearly half of which is directly caused by medical errors, such as misdiagnosis and incorrectly prescribed medication.

However, there are options employers and insurers can take to contain costs without offering less health care coverage. With any serious diagnosis or expensive treatment, a second opinion is always practical, especially if patients have unanswered questions. Sometimes, the answer is as simple as finding a doctor who specializes in a patient’s specific condition. Other times, the patient’s specialist is missing important information in his/her medical history. No matter what the question is, Best Doctors can help your members get to the right answer.

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