New technologies and treatments have caused the cost of large claims to rise. Simultaneously, the development of effective new gene-specific therapies has significantly increased Specialty Rx costs. For example, drugs like Skysona, a gene therapy medication used to slow the progression of neurologic dysfunction in boys 4-17 years of age with early, active cerebral adrenoleukodystrophy (CALD), cost over $3 million dollars per treatment, and health plans are under pressure to cover these costs. This becomes an enormous expense for employers to bear.
These costs will continue to trend in the double digits. In Q4 2022, into Q1 2023, trend rates for specialty prescription drugs are projected to increase by 10% to 12%.
Such conditions as mentioned above are difficult to deal with. $3,000,000 for a treatment plan seems outrageous especially when it is not a cure. However, CALD is also rare and thus the drug can be used by few people compared with widely used drugs.
Most people would want this treatment covered by their prescription drug plan, but may not realize that even one claim in an employer group will raise all premiums significantly depending on the size of the group.