Welcome to Million-Dollar Healthcare

The advent of million-dollar drugs is bad news for employers and, by extension, for the 61% of covered workers who participate in a self-funded plan.

Changes in U.S. health policy have made it more lucrative for drug makers to develop and sell high-cost drugs. Efforts to develop lower-cost versions of these drugs have been stymied. And this rampant profit-taking is taking a toll on patients as well as the U.S. health system.

The number of patients whose medical care cost at least a million dollars over the course of a year rose by nearly 90% between 2014 and 2017, according to a new report conducted by Sun Life. Dan Fishbein, president of Sun Life Financial U.S told MarketWatch, “We’re seeing drug claims that can be in the millions of dollars.

“Most people don’t imagine getting an $80,000 prescription, but that’s relatively common now.”

It’s not necessarily just patients feeling the squeeze. Many firms, particularly larger firms, choose to pay for some or all of the health services of their workers directly from their own funds rather than by purchasing health insurance for them. Today, 61% of covered workers are depend on a plan that is completely or partially self-funded.

If you are a self-funded employer, you are particularly vulnerable to the shift toward high-cost drugs. Contact one of Scripta’s pharmacy benefit experts for a review of your specialty drug management policy.

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Sourcing:

• “More and more health care bills are over $1 million—and expensive drugs are playing a major role,” Emma Court, Market Watch, July 16, 2018

• 2018 Employer Health Benefits Survey, “Section 10: Plan Funding,” Kaiser Family Foundation, September 19. 2017