The Rising Costs of Specialty Medication by Alexandra Connell https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp Costs and Access Barriers for Patients with Complex and Rare Diseases en-us 2022-06-26 17:17:40 UTC 2025-10-23 20:24:20 UTC hello@padlet.com Description alexandraconnell https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230723206 Specialty drugs are high-cost prescription medications that are used to treat complex, chronic conditions.

Healthinsurance.org, LLC (HIO). (2020). What is a Specialty Drug? Healthinsurance.Org. Retrieved June 26, 2022, from https://www.healthinsurance.org/glossary/specialty-drug/]]> 2022-06-26 17:32:24 UTC https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230723206 Classification alexandraconnell https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230724860 A medication is defined as "specialty" if it requires special handling, special administration, monitoring; or, is a high-cost oral medication.

Michigan Medicine. (2019, January 4). Specialty Medications by Condition | Michigan Medicine. Uofmhealth. Retrieved June 26, 2022, from https://www.uofmhealth.org/conditions-treatments/specialty-pharmacy-services/specialty-medications-condition#:%7E:text=A%20specialty%20medication%20is%20a,a%20high%2Dcost%20oral%20medication.]]> 2022-06-26 17:37:12 UTC https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230724860 Conditions alexandraconnell https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230731707 1. Inflammatory Conditions
2. Multiple Sclerosis
3. Oncology
4. Hepatitis C
5. HIV
6. Growth Deficiency
7. Cystic Fibrosis
8. Pulmonary Hypertension
9. Hempphilia
10. Sleep Disorders

Lauren Santye, Assistant Editor. (2022, January 4). Top 10 Specialty Drug Therapeutic Classes. Pharmacy Times. Retrieved June 26, 2022, from https://www.pharmacytimes.com/view/top-10-specialty-drug-therapeutic-classes]]> 2022-06-26 18:00:49 UTC https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230731707 Limited Access alexandraconnell https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230735882 Eighty-five percent of manufactures  manage some or all products through a limited distribution model according to the 2019 State of Specialty Pharmacy Report.

Pharmacy, A. S. (2020, February 4). What Are Limited Distribution Drug Networks, Anyway? Avella. Retrieved June 26, 2022, from https://blog.avella.com/what-are-limited-distribution-drug-networks-anyway]]> 2022-06-26 18:15:17 UTC https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230735882 alexandraconnell https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230740846 AARP found that the average annual cost for just one specialty medication used on a chronic basis is $78,781.

Specialty Prescription drugs are 12 times more expensive than brand name drugs and 215 times more expensive than generic name drugs. 

Specialty drug prices soaring past six figures per year. (2019, July 26). YouTube. Retrieved June 26, 2022, from https://www.youtube.com/watch?v=Fr9i2ZceJgg]]> 2022-06-26 18:24:42 UTC https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230740846 Workflow alexandraconnell https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230743276 Channels leading to dispensing of specialty products under the pharmacy benefit

Fein, A. J., PhD. (2018, July 12). Useful Overview of Specialty Distribution Models. Drug Channels. Retrieved June 26, 2022, from https://www.drugchannels.net/2012/07/useful-overview-of-specialty.html]]> 2022-06-26 18:30:18 UTC https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230743276 Authorized Distributors alexandraconnell https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230746999 Specialty pharmacies provide services that include training in how to use these medications, comprehensive treatment assessment, patient monitoring, and frequent communication with caregivers and the patient’s physician or other health care providers.

Byrne, M. P. (2021, March 5). The Ins and Outs of Specialty Pharmacy. Pharmacy Times. Retrieved June 26, 2022, from https://www.pharmacytimes.com/view/the-ins-and-outs-of-specialty-pharmacy]]> 2022-06-26 18:39:56 UTC https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230746999 Cost Barriers alexandraconnell https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230755343 As of 2020, Specialty Pharmaceuticals accounted for 50% of prescription costs despite representing only 1% to 3% of prescriptions written by medical professionals.

Specialty pharmacy costs were considered the top driver of rising health care costs in 2017. Eight in 10 employers ranked it among the top three factors in pushing health care costs higher.

The top five most expensive specialty pharmacy drugs cost, on average, $104,000 annually.

As a result many patients with complex and rare conditions that required specialty drug treatment were unable to afford copays to access their medications.

Ikeya, A. (2019, April 1). Containing the Escalating Costs of Prescriptions. Biz Journals. Retrieved June 26, 2022, from https://www.bizjournals.com/sanfrancisco/news/2019/04/01/containing-the-escalating-costs-of-prescription.html


]]> 2022-06-26 19:06:38 UTC https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230755343 Attributions to Cost alexandraconnell https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230757929 The high cost of specialty drugs can be attributed to the special handling they often require: prescription from a specialist, administration by a medical professional in a clinical setting, and significant patient management to make sure the drugs are being used correctly and safely.

The High Costs of Specialty Being Used Correctly and Safely. (2020, March 28). WellMark. Retrieved June 26, 2022, from https://www.wellmark.com/blue-at-work/resources/specialty-drug-prices#:~:text=The%20high%20cost%20of%20specialty,being%20used%20correctly%20and%20safely.


]]> 2022-06-26 19:16:13 UTC https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230757929 Specialty Drugs Carry a High Price Tag alexandraconnell https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230768300 Squires, T. M. (2022, June 6). Post author: Tyrone Squires, MBA, CPBS. TransparentRX. Retrieved June 26, 2022, from https://transparentrx.com/infographic-the-cost-of-innovation-how-specialty-drugs-impact-healthcare/]]> 2022-06-26 19:52:59 UTC https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230768300 Workers Face Increased Copays for Specialty Drgs alexandraconnell https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230768594 Squires, T. M. (2022, June 6). Post author: Tyrone Squires, MBA, CPBS. TransparentRX. Retrieved June 26, 2022, from https://transparentrx.com/infographic-the-cost-of-innovation-how-specialty-drugs-impact-healthcare/]]> 2022-06-26 19:54:03 UTC https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230768594 Authorization Barriers alexandraconnell https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230772527 The prior authorization process – a prerequisite for specialty medication therapy – is intended to ensure patients receive appropriate and effective treatment. However, it is one of many barriers to specialty medication access that can delay or prevent patients from starting therapy and create additional stress for patients and their caregivers.

Edwards, K. (2020, February 20). Embedded Specialty Pharmacy Team Removes Barriers to Specialty Medication Access. Trellis Rx. Retrieved June 26, 2022, from https://www.trellisrx.com/removing-barriers-to-medication-access/]]> 2022-06-26 20:07:48 UTC https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230772527 Access Barriers alexandraconnell https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230774104 Eighty-two percent of those prescribed specialty therapies reported spending an hour on the phone coordinating care to begin their therapy. Over a third spent at least three hours. Medication access and adherence challenges can be so significant for specialty patients, up to 27% of prescriptions and therapies are abandoned—or never started at all.

Conroy, E. C. (2021, March 23). Specialty access barriers: How technology can help. Pharmaceutical Commerce. Retrieved June 26, 2020, from https://www.pharmaceuticalcommerce.com/view/specialty-access-barriers-how-technology-can-help]]> 2022-06-26 20:12:24 UTC https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230774104 alexandraconnell https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230778302 The field of specialty pharmaceuticals is a lucrative field that serves a patient population with complex and chronic conditions. 

Any drug can be considered "specialty" if it meets certain requirements such as being high cost or requiring special handling or administration. 

Patients who are on specialty medications on average can spend over $104K annually on these agents. 

The nature of the specialty pharmacy industry mandates patients to utilize in network, limited distribution facilities that often make it very costly and difficult to receive these medications for both the patient and the healthcare providers trying to prescribe them. 

Specialty pharmaceuticals is the top driver of rising health care costs and accounts for half of all prescription costs globally. 

Due to distributing workflows mandated by drug manufactures, the complexity of navigating specialty pharmacies for newly enrolled patients and the exorbitant cost of these agents there exists delayed treatment or absence of treatment overall for this patient population. ]]> 2022-06-26 20:26:44 UTC https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2230778302 How Health Insurance Prior Authorizations Work alexandraconnell https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2232942600 How health insurance prior authorization works. YouTube. (2020, July 27). Retrieved June 28, 2022, from https://youtu.be/3yd6NpFyK50 ]]> 2022-06-29 02:01:58 UTC https://padlet.com/alexandraconnell/x0lfl45yhwjrs3pp/wish/2232942600