Costs of severely ill members and specialty medication use in a commercially insured population.
This study examines the overall profile and costs associated with severely ill commercially insured people. We found severely ill members to have the highest costs, from both the insurer and member perspective. Even for the most costly members where specialty medication use was highest, biologics represented less than one-third of the pharmacy spending and 6.6 percent of overall spending. Out-of-pocket spending rose dramatically when medications were paid for under the pharmacy benefit rather than the medical benefit. The advantages of paying for specialty medications under the pharmacy benefit should be evaluated in conjunction with the potential consequences of increased out-of-pocket burden.
Willey
Vincent J
VJ
Research Development and Operations, at HealthCore in Wilmington, Delaware, USA. vwilley@healthcore.com
Pollack
Michael F
MF
Lednar
Wayne M
WM
Yang
William N
WN
Kennedy
Charles
C
Lawless
Grant
G
D016527:Drug Costs / Q000706:statistics & numerical data*; D004363:Drug Utilization; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage; D007348:Insurance, Health / Q000191:economics* / Q000706:statistics & numerical data; D007356:Insurance, Pharmaceutical Services; D012720:Severity of Illness Index; D014481:United States