On the heels of World Cancer Day, we must continue raising awareness of life-altering conditions that impact many people worldwide. Whether a person is diagnosed directly, or it is the diagnosis of a loved one, cancer has become increasingly prevalent. In fact, an estimated four million people were newly diagnosed with some form of cancer in 2020. This number is expected to significantly rise over the next few decades.
While some forms of cancer are more avoidable depending on lifestyle choices, other forms are less preventable or predictable. One in two men and one in three women in the U.S. on average are diagnosed with cancer in their lifetime. For employers, these numbers paint a reality of just how likely it is that an employee, or an employee’s family member, is diagnosed with cancer. In fact, 57% of new cases occur in people 69 years of age or younger – a prime age range for those in today’s workforce.
An employer has a lot to consider if one of their employees or their loved ones is diagnosed with cancer. While showing support to help meet an employee’s needs is the top priority, it’s also critical to consider the toll a cancer diagnosis can have on the business. For instance, while urging an employee to take the time needed to get the proper care, there may be a period of diminished productivity and lost work time during treatment or recovery. But the impact doesn’t stop there.
The Rising Costs of Specialty Oncology Medications
Outside of crippling medical costs of treatments, oncology drugs represent nearly 50-60% of total cancer spend. The cost of these new drugs going to market continues to rise as such therapies target smaller patient populations and require additional research and laborious development. And if trends persist, the drug launch prices for specialty oncology drugs are estimated to be over $525 thousand by 2026.
Based on our 2022 data, these are the 10 most expensive cancer drugs and the average cost per claim employers need to watch out for:
1. Actimmune: average annual cost of $732,000
2. Adcetris: average annual cost of $696,000
3. Scemblix: average annual cost of $600,000
4. Ayvakit: average annual cost of $576,000
5. Qinlock: average annual cost of $468,000
6. Idhifa: average annual cost of $360,000
7. Welireg: average annual cost of $324,000
8. Exkivity: average annual cost of $288,000
9. Lenvima: average annual cost of $276,000
10. Xospata: average annual cost of $276,000
The impact and cost of being diagnosed with cancer don’t stop during – or even after – treatment. And if such medicinal treatments utilized by an employee are covered by an employer-sponsored pharmacy benefits plan, the employer may falter under the weight of an unexpected high-cost claim.
Get Protection to Support Employees Through a Life-Altering Diagnosis
With the high probability of an employee being diagnosed with cancer and the rising costs of oncology drugs, the likelihood of an employer being hit by an unexpected high-cost claim is significant — threatening to impact a company’s bottom line. Taking a wait-and-see approach to market changes or a common event like an unexpected cancer diagnosis can be disastrous for an employer when the opportunity to prevent a financial misfortune is too late.
Prevention is key to effectively controlling costs and managing risks. It requires planning for potential medication needs before they become real and challenging scenarios.
Stop-loss insurance can protect an employer if hit by a large specialty claim — but it has its limitations. Stop-loss contracts can be limited to one year and often incur significant rate increases following large claims. Or the employer may see their protection disappear completely because of lasering.
Fortunately, a supplemental insurance solution like RxPharmacy Assurance is available. It offers multi-year protection against skyrocketing prescription benefit costs. Click here to learn how this additional protection can truly minimize risk and save an employer’s bottom line.