Cost drivers for increased drug spend on specialty pharmaceuticals include increased utilization, expanded indications, and the introduction and development of new biologic agents.

Key management strategies for specialty pharmaceuticals include the implementation of specialty tiers and complex formulary designs, drug restrictions through prior authorizations and quantity limits, co-payments and co-insurance rates that increase patient cost burden, specialty pharmacy provider use for drug distribution, medication therapy management programs to increase coordination of care, quality measures enforced through healthcare reform and accountable care organizations, increased use of evidence-based medicine, and government regulation for biosimilars and price controls.

Continued development of specialty pharmaceuticals in the biopharmaceutical industry pipeline, primarily targeting orphan diseases, oncology, hepatitis C, inflammatory conditions, multiple sclerosis, and HIV, coupled with the introduction of biosimilars, will affect the cost impact of these drugs and evolve drug utilization and cost-management strategies.