More and more employers are eliminating specialty drug coverage entirely. They really have no choice.
Imagine a small employer group of 250 employees assuming outright the risk of $1 million for Smoker Smith who now has lung cancer and is taking one of the new specialty drugs costing $85,000 per month. There is no way for the employer to continue his group medical plan.
Specialty drug prices are driving self-funded plans into bankruptcy. Forget about stop loss insurance protecting plan assets when renewal time comes around. A stop loss underwriter’s best cost containment strategy, and the most feared by plan sponsors, is the inevitable laser.
Imagine a small employer group of 250 employees assuming outright the risk of $1 million for Smoker Smith who now has lung cancer and is taking one of the new specialty drugs costing $85,000 per month. There is no way for the employer to continue his group medical plan.
More and more employers are eliminating specialty drug coverage entirely. They really have no choice.
New Immunotherapy Costing $1 Million a Year
SOURCE: Medscape News & Perspective
One of the new immunotherapies (Pembrolizumab) would cost more than $1 million per patient per year at the higher dose currently being studied in many different cancer types, an expert has warned.
“This is unsustainable…. We must acknowledge that there must be some upper limit to how much we can, as a society, afford to pay to treat each patient with cancer,” said Leonard Saltz, MD, from Memorial Sloan Kettering Cancer Center, New York City.
He gave the alarming example of a drug that would cost more than $1 million.
The latest immunotherapy, pembrolizumab (Keytruda, Merck Sharp & Dohme Corp), was approved at the end of 2014 for use at a dose of 2 mg/kg for the treatment of melanoma. For this, it costs around $14,500 per month.
But a much higher dose of 10 mg/kg, pembrolizumab is now being used in clinical trials (featured in five abstracts presented at the ASCO meeting), and this higher dose works out to be $83,000 per month.
In calculating what the expense would be for a year, Dr Saltz dropped the weight of the hypothetical patient to 75 kg; for such a patient, pembrolizumab at the higher dose of 10 mg/kg (26 doses per year at $51.79 per mg) would cost $1,009,944 per patient per year.
Can a plan eliminate Specialty Drugs & remain ACA compliant?
