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Consider this: a self-insured business owner employs a person that is diagnosed with cystic fibrosis. The employee is then prescribed a high-cost specialty medication to help manage the chronic condition. While the treatment is necessary to the employee's health and well-being, the self-insured plan sponsor will likely need to cover the costs in perpetuity, which may cause a financial burden.
Specialty drug utilization is not expected to slow any time soon, as the volume of specialty claims continues to grow year after year. In fact, according to the 2021 State of Specialty Spend and Trend Report, there was an 8.3% increase in the average number of claims per specialty utilizer. What's more, many newly approved drugs were developed to treat small populations or orphan indications and are thus very expensive, leading to growing concerns on the part of plan sponsors that they may be unexpectedly hit with a significantly high-cost claim.
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