Sovaldi, the new drug that treates hepatitis C, created quite a buzz with its $84,000 price tag for a 12-week course of treatment when it hit the marketplace late in 2013. Other high-cost specialty drugs are not far behind, nor was Sovaldi the first to rattle payers’ decision-making abilities.
In fact, another hepatitis C drug, Harvoni, has already overshadowed Sovaldi, costing $95,000 for a 12-week regimen. A once-a-day pill, it was approved in October.
While these high-cost drugs may prove to be superior to their predecessors—studies have shown they can eliminate the virus and Harvoni may even shorten the treatment cycle—that still leaves payers in a quandary about how to pay for them.
Expect to see within the next two years, new drugs for cancer—especially lung cancer—heart failure, schizophrenia and some for chronic diseases such as asthma and hyperlipidemia.
Keytruda, approved in September for advanced melanoma, has an estimated cost of $12,500 per patient per month, according to FiercePharma. Its ability to disrupt a process in which cancer cells tell the immune system to not attack them, is the first of its kind to be approved in this country. It targets patients who do not respond to other drugs.
Health plans and pharmacy benefits managers are using new and some tried-and-true tools to manage the skyrocketing costs for specialty drugs.
Besides creating formularies in accordance with federal laws, plans focus on providing patients access to prescription drugs in the most affordable manner for everyone and designing options to meet consumers’ healthcare needs across the spectrum, says Patrick Johnston, president and chief executive officer of the California Association of Health Plans,
“There also needs to be a clear discussion about whether the ‘newest’ is the best value or most effective treatment,” he says. “Often an older medication is just as effective at half the cost. The answer is not a one-size-fits-all approach.”