Why are Prescription Drug Costs Rising Rapidly Again?

Posted: April 25, 2016 - Benefits Consulting

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Specialty Medications – Great Potential, Great Cost.

Years ago high cost specialty prescriptions were designed for small patient populations. Today, new prescriptions coming to market are designed to treat more common chronic conditions. Some of these chronic conditions are developed later in life so as our population continues to age, the utilization of these prescriptions will also continue to increase.

Since 2014, the FDA has approved over 30 new treatments for health conditions including hepatitis C, certain cancers, diabetes, HIV, and heart failure. The success rate of some of these new treatment options is impressive. For example, new hepatitis C treatments have efficacy rates close to 100% but the cost of one full treatment course can reach close to $100,000 per patient.

What Can Patients Do To Control These Costs?

  • Talk to your doctor:       Your doctor may be aware of programs that can help people who need assistance with paying for their prescription.       Also talk to your doctor about all of your treatment options. Some doctors gravitate toward their “go to” prescription without discussing or knowing your financial responsibility. Lastly, discuss the possibility of waiting. Your doctor may be aware of a lower cost treatment option that is ready to hit the market soon.


  • Look into patient assistance programs and speak with your pharmacy: There are several websites that provide good information such as NeedyMeds.org and RxAssist.org. Your pharmacy may also be able to provide suggestions.
  • Speak directly with the drug manufacturer: Begin by going to their website.

Insurance companies are also taking steps to help their employer clients control these costs. Steps include:

  • Requiring employees to purchase specialty prescriptions through a designated pharmacy which offers the most significant discount.
  • Creating value based payment models such as Accountable Care Organizations (ACOs). These provider payment models hold providers accountable for quality outcomes and cost management.
  • Reviewing the best prescription administration options (i.e. member self-administers the prescription at home or at a physician’s office).
  • Working with interested parties to create better transparency from drug manufacturers on items including price, clinical research, efficacy, and patient complications.

We all have a vested interest in making sure the best treatment options are available at the most affordable cost. Emerging trends like this also underscore the importance of partnering with a high quality health insurance carrier.

John Jaeger

CDH has partnered with OneDigital to deliver a powerful new approach to employee benefits by combining the commitment of experienced, local market advisors with the sophisticated technology and resources of a respected national firm. As the employee benefits landscape becomes increasingly complex, we know the needs of your organization are shifting. John Jaeger and his team of dedicated benefits professionals are your personal experts in developing a strategic plan specific to your company’s business goals and employee initiatives. https://www.onedigital.com