Prescription drug innovation continues to accelerate, offering new hope for individuals living with chronic and complex conditions. As the industry celebrates therapeutic breakthroughs, we’re also seeing significant growth in the cost of prescription drugs, specifically specialty drugs.
Specialty drugs: Managing steep costs
The cost of specialty medications continues to rise as more specialty medications and treatments become available on the market, including those for orphan and rare disease therapies. Specialty drugs are one of the largest drivers of rising health care costs today, and prescription drug spending is expected to continue to rise by four to seven percent annually1 over the next four years.
AmeriHealth Administrators has a multi‑pronged approach to curb specialty drug costs without impacting member access to quality care including, but not limited to, investing in biosimilars and our Most Cost‑Effective Setting (MCES) program.
Biosimilars: A high-value opportunity
Alternatives to biologic medications, known as biosimilars, offer the same safety and effectiveness as the original drugs, and similar to generic drugs, they drive market competition.
Why this matters to your plan:
- Biosimilars introduce market competition, driving down prices.
- They offer more cost‑effective treatment options for conditions like cancer, rheumatoid arthritis, and Crohn’s disease.
- AmeriHealth Administrators employs preferred drug strategies and exclusive contracting with biosimilar manufacturers to maximize cost savings.
We’re actively monitoring and identifying opportunities to leverage biosimilars to maximize our cost savings opportunities for our clients.
Site of care: Responsible steering
One of our most powerful tools in combatting rising specialty drug costs on the medical benefit is managing the site of care through our MCES program. For many specialty drugs administered by a health care professional, administration in a doctor’s office, infusion clinic, or in the home via a nurse is not only more convenient to the member, but also significantly reduces costs.
The MCES program has saved over $250 million since 2012. Our Utilization Management procedures and provider contracting facilitate site of care coordination and significantly reduce the added costs associated with the administration of high‑cost medical specialty drugs.
What this means for you
As an employer, you want to offer benefits that meet the evolving needs of your employees without compromising plan sustainability. AmeriHealth Administrators supports you with:
Rigorous drug evaluation:
We base coverage decisions on clinical evidence, cost‑effectiveness, and overall value to member care.
Strategic pharmacy management:
We identify opportunities to steer utilization to lower cost drugs and administration of medical specialty drugs to the appropriate sites of care, without a negative impact to member care.
Transparent member tools:
Employees can easily check covered medications, find lower‑cost alternatives, and estimate out‑of‑pocket expenses through the AmeriHealth Administrators portal and mobile app.
Looking ahead
The pace of innovation in health care isn’t slowing down, but neither is our commitment to helping you manage it. At AmeriHealth Administrators, we’re focused on delivering smarter drug coverage that balances cost control and access to high‑quality care.
You can count on us to keep monitoring the market, adjusting strategies, and advocating for your business and your people every step of the way.
For more information, contact your AmeriHealth Administrators account executive.
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1 https://www.iqvia.com
This content was originally published in the AmeriHealth Administrators Insider email newsletter.