Although a number of highly specialized medications are entering practice with increasingly higher price tags and additional costs beyond administration, evidence suggests that it is worthwhile for the overall health care system to cover them.
Analysis of 102 traditional and specialty drugs approved by the Food and Drug Administration between 1999 and 2011 showed that, while traditional drugs generally showed little additional benefit when compared with comparator products available at the time of approval, the 58 specialty drugs, in the aggregate, generally showed higher efficacy and cost effectiveness, James Chambers of Tufts University, Boston, and his colleagues wrote (Health Aff. 2014;33:1751-60 [doi:10.1377/hlthaff.2014.0574]).
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More specialty drugs should be covered by insurers due to their high cost-benefit ratio, Mr. Chambers said.
Mr. Chambers and his colleagues found that 5 of the 15 drugs with the largest additional cost also were among the 15 drugs that showed the largest additional benefit, measured in gains to quality-adjusted life years.
Overall, 14 of the specialty drugs and two traditional drugs offered more than 6 months of quality-adjusted life expectancy.
“Specialty products were often introduced for diseases with substantial unmet health needs, such as cancer or multiple sclerosis,” the authors wrote. “In contrast, many of the traditional drugs in our sample were indicated for conditions … that have been fairly well-managed.” Thus, there was plenty of room for specialty products to improve over existing standards of care while many of the traditional drug products already were coming into a crowded field.
Although specialty drugs are shown to offer improvements to health, payers “have not yet found the formula for managing specialty drugs,” authors noted. “Insurers should continue to experiment with a combination of existing and novel strategies to maximize patient access to specialty drugs while minimizing their cost.”