Specialty Medications: A Case Study

The demand for specialty medications will significantly increase. By 2020, 9.1 percent of healthcare spending will be for using specialty medications. After the Orphan Drug Act was enacted into law in 1983, more and more biological products and new medications have been developing to treat rare and critical diseases. Also, the Affordable Care Act ensures that patients cannot be denied coverage for pre-existing or high-cost conditions, which may require specialty medications. These laws create opportunities for new medications to be marketed and increase access to those medications (PBA Health, 2015). However, the costs may range from $30,000 to $100,000 annually, of which patients’ copayments are usually very high for Medicare and commercial plans. …show more content…
On the other hand, depend on Medicare plans, patients are responsible for very high copayment of a few thousand dollar until they reach $5000 out of pocket and enter catastrophic phase, which they are responsible for 5% cost of the medications for Medicare Part D. Patients are responsible for 20% of specialty medication costs if they are covered under Part B. Because all specialty medications’ costs range from $3000 to $20,000 per month, Medicare patients continue to have high copayments after reaching catastrophic phase, which are heavy burdens for the elderly when their incomes mainly come from social security benefits. Deciding to start costly treatments and adhering to the therapies are big concerns of Medicare patients, which is also a challenge for providers to manage patients’ treatments. SP services are able to alleviate the