Specialty Pharmaceuticals: To Compare Cost with Value, More Productivity Research is Key

Specialty pharmaceuticals often represent the most effective—and sometimes the only—option for treating or curing life-threatening diseases such as HIV/AIDS, cancer and hepatitis C. Despite their therapeutic value, specialty pharmaceuticals recently have garnered attention for their high costs– in excess of $100,000 per year, in some cases.

A new commentary published by IBI in The American Journal of Pharmacy Benefits argues that the value of specialty pharmaceuticals–to patients, employers and society at large–has been left out of the discussion.

IBI’s Research Director, Brian Gifford, Ph. D., argues that the combination of high-cost medications and insurance plans with high out-of-pocket costs may prompt some patients to forego necessary and beneficial care for serious medical conditions. Costs due to lost productivity could be high if worsening illness leads to more sick days, disability leaves or exits from the labor force. Yet few studies have looked seriously at the impact of specialty pharmaceuticals and productivity.

“The prices of these drugs are high, but the cost of denying people access to them is likely higher”, said Gifford. “Decisions are being made about the cost-effectiveness of specialty pharmaceuticals without fully understanding their benefits–including whether they help keep people functioning and on the job.”

Fully understanding the costs and benefits of specialty pharmaceuticals requires research that can close the following evidence gaps:

  • How many people have limited labor force participation because of a serious but treatable condition?
  • How do earnings, payroll taxes, receipt of social safety net benefits, unemployment rates and underemployment rates for people treated with a specialty pharmaceutical compare to those for people with the same condition receiving usual care or no care?
  • What is the projected total economic value of a specialty pharmaceutical in terms of improvements in labor force, wages, payroll taxes, public social benefits such as social security disability benefits (SSDI), and productivity outcomes relative to the costs of treatment, and how does this compare to usual care or no care?

IBI’s commentary describes a feasible research agenda on the overall costs and benefits of specialty pharmaceuticals. Cumulatively, the findings could provide stakeholders such as employers, policymakers and patients’ groups with empirical evidence on which to formulate specialty pharmaceutical policies.

Read the full commentary here.

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