Specialty pharmaceuticals: to compare cost with value, more productivity research is key

A new commentary published 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.

A new commentary published by the Integrated Benefits Institute (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, 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 labour 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:

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.