Specialty Medications — The Fastest Growing Healthcare Expense

Hospital claims may receive the attention, but specialty prescription drugs are now one of the fastest-growing drivers of healthcare costs.

Many of these medications are the commercials you see advertised during television programs every night.

Drugs such as:

• Skyrizi®
• Dupixent®
• Humira®
• Stelara®
• Ocrevus®
• Ozempic®
• Wegovy®
• Mounjaro®
• Zepbound®

can cost tens of thousands of dollars every year for a single patient.

Some specialty medications exceed $100,000 annually, while newer therapies can cost several hundred thousand dollars.

Why Are They So Expensive?

Unlike traditional medications, specialty drugs often:

• Treat chronic or complex diseases.
• Require extensive research and development.
• Are biologic medications rather than traditional pharmaceuticals.
• Require special handling or administration.
• Have little or no generic competition.

Many are used to treat:

• Rheumatoid arthritis
• Psoriasis
• Crohn's disease
• Multiple sclerosis
• Cancer
• Rare genetic disorders
• Severe asthma

GLP-1 Medications Are Changing Healthcare Costs

One of today's biggest pharmacy cost drivers is the rapid growth of GLP-1 medications, including:

• Ozempic®
• Wegovy®
• Mounjaro®
• Zepbound®

Originally developed to treat diabetes, these medications are now widely prescribed for weight management.

While they can produce remarkable clinical outcomes, they often cost over $1,000 per month per patient.

When multiple employees begin using GLP-1 medications, pharmacy spending can increase dramatically.

Why Employers Should Care

For many health plans, pharmacy spending now rivals hospital spending.

Employers are increasingly evaluating:

• Formulary management
• Prior authorization
• Clinical review programs
• Alternative funding programs
• Pharmacy benefit optimization

Managing specialty medications has become one of the most important strategies for controlling healthcare costs.