Getting Creative in Combating Rising Specialty Drug Costs

Pills dollar symbol

High cost drugs are the most significant cost driver in healthcare today. Because of their therapeutic value (they cure illness), it is very difficult to manage the cost of these specialty medications. Prior approval, quantity limits and high cost-sharing have proven to be among the most effective utilization mechanisms. A study published in The Journal… [Read More]

Pharmacy Shenanigans

Prescription Drug Cost

In evaluating the cost of a medical benefits program, prescription drug costs and in particular, specialty drugs, stand out as the fastest growing and the most difficult to manage cost. As I review programs with clients, I find myself often pointing out that pharmacy is where all the profits are hidden. This has been no… [Read More]

Controlling Specialty Drug Spending

Drug Cost  Specialty Pharmacy

Another commentary from the National Blue Cross Consortium. As I mentioned in prior posts, large claims are on the rise. Last year, Blue Cross paid their first individual claim for more than $15M, and the frequency of claims over $1M tripled from 2010 to 2015. Specialty medications are a real focus area. There is a… [Read More]

Mandatory Mail Order Rx and the Privacy Dilemma


We have been hearing a lot about the explosion in the cost of specialty Rx that is leaving insurers, health plans, and governmental payors virtually defenseless against their cost (see Sovaldi). One of the mechanisms being deployed to combat the rising price tag is mandatory specialty Rx oversight.  What this basically does is cede total… [Read More]

Express Scripts’ Acquisition of Medco and the Prescription Drug Marketplace


I am excited to share some of my observations from the annual Express Scripts/Medco Leader’s Conference held last week. Drug Cost Trends Clearly, prescription drug cost trends are flattening. Despite the fact that we are living longer and have a greater incidence of chronic and complex conditions, in 2011, the year over year drug cost increase… [Read More]