With roughly 20 cents of your premium dollar going to the cost of prescription drugs, it may come as a surprise that about half of that amount is dedicated to paying for specialty drugs – a class of prescription used to treat a variety of complex conditions. With more people taking specialty drugs, finding ways to lower costs is a priority.

What are specialty drugs?

Specialty drugs are often biologics, meaning they are derived from living cells. They are often administered by an injection via syringe or injectable “pen,” or by an infusion through an IV bag at a hospital or infusion center. There are hundreds of specialty drugs on the market to treat complex conditions and serious diseases including:

• Autoimmune conditions such as rheumatoid arthritis, ulcerative colitis, Crohn’s disease, psoriasis, certain types of asthma and HIV
• Breast and blood cancers
• Multiple sclerosis
• Fertility challenges

Why specialty drugs are so costly

Specialty drugs often require special handling and storage. They are typically approved for very limited uses and often have strict monitoring requirements. These factors contribute to the costs of the drugs, which average about $84,000 per year when used on an ongoing basis.

How Horizon is helping patients get the specialty medications they need

Because the administration of specialty drugs often requires patients to travel to a hospital, infusion center or outpatient facility, Horizon created a program in 2018 to help make treatment more accessible and convenient. Through our Site of Service program, prescribing doctors work with their patients and Horizon to identify opportunities for patients to self-administer drugs, have drugs administered at home by a clinician, or administered at sites closer to patients.

Since its inception, the program has saved patients time and money.

Additionally, Horizon manages a number of other programs to ensure appropriate use of specialty drugs, including a dose optimization program which reduces drug waste with certain injectable drugs and Pharmacy Case Management whereby Horizon pharmacists reach out to certain members to coordinate care, answer any questions and address any gaps in care.

Are there alternatives to specialty drugs?

Just as some brand named prescriptions have a generic alternative, so do some specialty drugs.  Biosimilars are biologic drugs that have no clinically meaningful difference from an existing biologic medicine already licensed by the U.S. Food and Drug Administration (FDA). Biosimilars cost less than their brand-name biologic counterparts.

The FDA has approved 36 biosimilars to date, 23 of which are currently on the market and available to patients. Horizon and its Specialty Pharmacy Benefit Manager, Magellan, follow the development and approval of biosimilar and biologics closely, with the goal of keeping members fully informed of their choices for safe and effective medications.

Members with questions about medication alternatives should always consult with their doctor for guidance.

Magellan is an independent company that supports Horizon Blue Cross Blue Shield of New Jersey in the administration of specialty pharmacy benefit management services to Horizon Blue Cross Blue Shield of New Jersey members. Magellan is independent from and not affiliated with Horizon Blue Cross Blue Shield of New Jersey.