Relentless Health Value

Members taking specialty drugs represent about 2% of any given employer’s population but often consume as much as 30% of an employer’s total cost of care. As Pramod John, PhD, in EP353 has said, this isn’t just small companies we’re talking about here. Some of the largest employers in the US are dropping big bucks on specialty drugs, and they are obviously overpaying and don’t need to.  No employer or plan really need pay any more than the pharmacy’s acquisition price plus a reasonable professional fee. But so many employers pay way more than that. Let’s just keep in mind that specialty pharmacy spend extends beyond just pharmacy spend. Medical claims for pharma drugs that are infused, for example, can be more than 50% of an employer or plan’s specialty pharmacy spend. What I’m talking about now is buy and bill–type stuff where a hospital or physician practice bills for an infused pharmaceutical product under a patient’s medical benefit. Listen to EP370 with Autumn Yongchu and Erik Davis about how some hospit