Specialty Drug Costs Are Rising. Here’s How Employers Can Save up to $87PMPM with a More Integrated Approach

Pharmacy benefits are one of the biggest and least predictable costs in your health plan. They are also one of the fastest-growing drivers.

Specialty drugs are a big reason why. These medications treat complex or chronic conditions and often come with a high price tag. While they make up a small share of prescriptions, they account for more than half of total pharmacy spend.

For employers, this creates real pressure. A small number of high-cost claims can quickly impact your overall spend, making it harder to plan and budget year over year.

As more of these therapies enter the market, many employers are looking for ways to manage costs. Some are turning to solutions that promise quick savings.

But those savings do not always tell the full story.

Making informed decisions helps to understand what drives specialty costs and how different approaches can impact your plan over time.

What’s driving specialty drug costs right now

The specialty drug pipeline continues to grow, and it is changing how employers think about pharmacy benefits.

New therapies are being developed for more conditions, including rare diseases and complex chronic illnesses. Many of these treatments are highly effective, but they are also expensive.

At the same time:

• More members are using specialty medications
• Treatments are being introduced earlier in care
• Costs per therapy continue to rise

That growth does not just increase costs. It increases uncertainty, especially when even one or two claims can significantly impact your total pharmacy spend.

This creates a challenge for employers. You want to support access to care, but you also need predictable and sustainable costs.

Why separate specialty pharmacy programs can fall short

With rising costs, solutions that keep specialty pharmacy programs separate can seem appealing. They often promise immediate savings by separating specialty drugs from the rest of your pharmacy benefit. Many of these models rely on manufacturer assistance programs to reduce costs. At first glance, that can look like a win. But there are trade-offs.

These programs:

• Do not apply to every member or medication
• Can end at any time
• May delay access to treatment
• Can make it harder to see the true cost of care

They can also create gaps in coverage or disrupt the member experience.

Over time, this can lead to less predictable costs and more complexity for both employers and employees. That means the savings you expect may not show up the way you planned, or may not last.

In some cases, you may also lose visibility into total costs, making it harder to manage long-term trends and make informed benefit decisions.

Short-term savings may come at the expense of long-term stability.

A more sustainable approach: integrated specialty management

Instead of carving out specialty drugs, many employers are taking a more integrated approach. This means managing specialty medications as part of the full pharmacy and medical benefit, not in isolation.

With an integrated model:

• Costs are managed through negotiated pricing and rebates
• Care teams look at the whole patient, not just one medication
• You have full visibility into both medical and pharmacy spend
• Savings are more consistent and easier to track

This approach also gives you greater control over cost trends, with fewer unexpected spikes throughout the year. When benefits work together, members are more likely to stay on treatment and avoid disruptions. Employers can see more predictable costs and better long-term outcomes.

In some cases, integrated models have shown meaningful savings compared to standalone approaches, along with improved care coordination and fewer downstream costs like hospital visits.

Why this matters for your health plan

Specialty drug costs are not going away. The pipeline will continue to grow, and new therapies will keep entering the market. That means the decisions you make today will have a lasting impact on your overall health plan costs, member experience, access to care, and your ability to plan and forecast.

The question is not whether to manage specialty costs. It is how.

A fragmented may offer short-term relief, but they can introduce risk and complexity. Integrated strategies focus on building savings into the plan from the start while keeping care connected and consistent.

Managing specialty drug costs requires more than a quick fix

As new therapies continue to shape the future of care, employers need solutions that are stable, transparent and built for long term.

Specialty costs will continue to rise. The difference is whether your strategy helps you stay ahead of that trend or forces you to react to it after the fact.

Taking a more integrated approach can help you balance cost, access and quality without sacrificing one for the other.

If you are evaluating your pharmacy strategy, now is the time to look beyond surface-level savings and consider what will work best over time.

Disclaimers:

1. What Are the Projected 2025 Health Plan Cost Trends? Segal. September 18, 2024. Accessed April 8, 2026. https://www.segalco.com/consulting-insights/2025-health-plan-cost-trend-survey