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The cost of specialty pharmaceuticals

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Specialty pharmaceuticals, which include difficult-to-manufacture small-molecule chemical drugs and biologicals, account for approximately 25% of total prescription costs, with expenditures on specialty prescriptions expected to quadruple by 2020 [1]. In fact, the absence of competition upon patent expiration has enabled the cost of biological drugs to increase seemingly without a ceiling.

Historically, the larger the population for which a medication was prescribed, the more valuable the drug, but today, most of the drugs fitting the description of blockbuster are used for far less common treatment indications and for far fewer patients. In 2010, at least six of the top 10 blockbuster drugs in the US were used for more than 1.65 million patients, examples include clopidogrel (5.1 million) used to stop blood clots and cholesterol-lowering medication atorvastatin (4.9 million).

In contrast, in 2014, only two of the top 10 blockbuster drugs in the US were used in patient populations of a similar size. In fact, the top two drugs, hepatitis C treatment sofosbuvir and arthritis treatment adalimumab, were used in patient populations of only 135 and 246 thousand, respectively. However, despite the low number of patients treated they still managed to bring in US sales of US$10.1 and US$6.1 billion, respectively. For sofosbuvir, this is a whopping 4 billion more than the number one blockbuster of 2010, see Table 1.

Table 1: Sales and patients treated with blockbuster drugs in the US

Specialty medications, both biologicals and small-molecule drugs, have improved the quality of treatment for numerous patients, and subsequent products aim to provide even better patient outcomes.

However, the cost associated with these innovations impairs the ability of healthcare organizations to provide treatment to their entire patient populations. Health-system pharmacists should expand their understanding, not only of the clinical considerations related to these products and their therapeutic classes, but also the financial implications of their use from the perspectives of payers, providers, and especially, patients.

Related articles
Biologicals sales have almost doubled since 2006

Generic drug prices decrease, brand-name prices increase

Reference
1. Lucio S. The increasing impact of high-cost specialty therapies. PPPMag. 2015;12(2):10-17.

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