Specialty drug price caps drastically reduce out-of-pocket costs without increasing health plan spending

States that implemented out-of-pocket price caps for expensive specialty drugs saw patient spending on these medications decrease $351 per month, according to new analysis published in the New England Journal of Medicine.

Delaware, Maryland and Louisiana passed laws that placed $150 price caps on patients' out-of-pocket costs for specialty prescriptions, such as those that treat multiple sclerosis and rheumatoid arthritis. These laws resulted in a 32 percent decrease in spending for patients in need of these drugs, but did not lead to any changes in health plan spending per patient.

The study highlighted that health plan spending for specialty drugs has shot up from around 26 percent of total drug spending to 49 percent in the past 10 years, even though these medications make up less than 2.5 percent of prescriptions

"One of the positive findings here is that people we wanted to help were, in fact, helped," Stacie Dusetzina, PhD, one of the study's authors, told STAT. "All other proposals out there may face less resistance among those who believe this will drive up health plan spending and premiums."

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