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I’ve commonly heard the term 'specialty drugs' in the insurance industry. What are these and how do they affect my group benefits plan?

Posted Oct 3rd, 2016 in Employer FAQs

Specialty drugs are usually expensive drugs that are meant to treat rare conditions of severe ailments such as multiple sclerosis or rheumatoid arthritis.

They typically require prior authorization, special handling, administration or monitoring.

Prior authorization means the insurance company will need to review why the specialty drug has been prescribed before agreeing to provide coverage for it. If prior authorization is not obtained, the medication may cost more or it may not be covered at all.

Specialty drugs are usually covered under the prescription drugs benefit of your group benefits plan and can adversely impact your group’s claims experience as these drugs range anywhere from $3,000 - $35,000 per year. In rare cases, some of these newly developed drugs cost in the tens and hundreds of thousands per year, putting many family financial resources under an unbearable strain.

At Revolution, we advise our clients on how to design a plan that would reduce the impact of drastic drug claims while controlling costs and providing the care and protection needed for their employees.


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