How will Biologic Drugs Impact Benefit Plan Costs?

Pharmaceutical companies are constantly working to create new marketable drugs; every so often, an entire class of prescription medication is introduced to the scene, the newest of which have been dubbed biologics. This category of drugs is quite different from other classifications in that they are manufactured from actual living organisms, thus steering away from the conventional, synthetic compositions long associated with the industry.

Biologics and benefit plans

Biologics account for a considerable portion of benefit plan expenditures. When talking about prescriptions that can cost upwards of $3,000 per month in some cases, it is no surprise that healthcare providers have kept a watchful, scrutinizing eye on their development.

The effect on premiums pertaining to biologics has been thoroughly studied as well, and for good reason. Many patients need to sample various kinds of these drugs before finding the one best suited to treat their health condition, which in turn drives up costs. To prevent the latter from getting out of control, a majority of benefit plan providers stipulate that patients must utilize the most cost-effective treatment available to them at the time, so as to keep premiums in check.

Another way healthcare providers have reacted to the high cost of biologics is by presenting cheaper alternatives, namely the Subsequent Entry Biologic subset that typically run one-fifth less to manufacture. Immunomodulators and antineoplastics continue to be the one classification of biologics that have a major impact on drug benefit plans in Canada, each of which has been around since the turn of the millennium.

No one can deny the fact that these drugs have led to an increase in benefit plan costs, but it remains to be said that they are also needed by a sizable number of patients who are suffering from serious health conditions. Striking the balance between the types of drugs needed (including possible generics) and their associated costs with respect to benefit plans is crucial. Healthcare providers are inclined to revise existing policies to ensure they are in line with current pharmaceutical developments and marketplace demands.