July 2020 Volume 7 Issue 13
Providing Current Information on

Health Insurance Industry Issues and Legislation

Specialty Drug Prices Just Keep Going Up
The most expensive Specialty Drugs just keep getting more expensive. Pharmaceutical
companies increased the prices of 4 of the 5 the highest priced drugs at the beginning
of the year. Additionally, they introduced 2 new drugs in 1919 with list prices over
$30,000, making them 2 of the 20 most expensive in the U.S., according to the latest list
published by GoodRx
Reducing Specialty Drug Medical and Pharmacy Costs
Medical and pharmacy costs each make up about half of the total specialty drug
related spend. There are a number of specialty drug cost containment services
dedicated to helping reduce costs for both plan sponsors and members using highcost
specialty drugs. Most focus solely on reducing pharmacy costs by identifying
and accessing alternative sources of payment funding. One, SmartPayRx goes
further; working to reduce specialty drug related medical costs as well, generating
significantly more savings for plan sponsors and members.
Preparing for the Health Benefits Road Ahead
Everyone has been and continues to be engaged in responding to the impact of
COVID-19 on their and their clients' organizations. While these efforts must continue,
it is also important to start addressing plan benefit management for the future. Trends
in employee population, costs, complications and mental health needs will all need to
be considered. There are five best practices for collecting health data to help effectively
understand these trends and help shape health benefits in these uncertain times.
Specialties Sending the Most Surprise Bills
Surprise medical bills from out-of-network providers continue to be a major focus of
healthcare reform. A recent study by the Health Cost Institute found that less than half
of doctors in the 6 specialties studied - Anesthesiology, Behavioral Health, Cardiology,
Emergency Medicine, Pathology and Radiology ever balance bill patients and that
those who do balance bill patients less than 10% of the time.
Three Star Preferred Provider Program Additions
Maria Domingues, OD
Irvington, NY 07111

Castle BioSciences, Inc.
Dallas, TX 75312

RJ Dental Teaneck
Teaneck, NJ 07666

Xiaoxiong L Shen
Gardena, CA 90248

Qualitox Lab
Eugene, OR 97402