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GAO-09-517R 1 (2009-04-30)

handle is hein.gao/gaobaanne0001 and id is 1 raw text is: I GA 0 LV.WX11M§= Accountability * Integrity * Reliability United States Government Accountability Office Washington, DC 20548 April 30, 2009 The Honorable Edward M. Kennedy Chairman Committee on Health, Education, Labor, and Pensions United States Senate Subject: Federal Employees Health Benefits Program: Enrollee Cost Sharing for Selected Specialty Prescription Drugs Dear Mr. Chairman: Recent increases in prescription drug costs have been fueled in part by the high and rising cost of specialty prescription drugs.' Specialty prescription drugs are typically used to treat chronic or life-threatening conditions, such as multiple sclerosis and cancer, for which few other treatment options exist. The drugs typically have few competitors or generic alternatives and may require frequent dosage adjustment, special storage, patient education, or special methods of administration, such as by injection. Costs for specialty prescription drugs are usually high, typically ranging from $1,200 to $40,000 for a 30-day supply. Health plans-including those participating in the Federal Employees Health Benefits Program (FEHBP), which covers nearly 8 million federal employees, dependents, and retirees- provide coverage for many specialty drugs. Enrollees may be required to pay a portion of specialty drug costs through a copayment-a flat dollar amount-or coinsurance-a percentage share of the drug's actual costs.2 To manage the high and rising costs of these drugs, some health plans have begun to require enrollees to contribute a greater share of their costs, such as by increasing the use of coinsurance. You asked us to examine the costs that FEHBP enrollees may incur for specialty prescription drugs. In this report we describe cost-sharing requirements and limits for specialty drugs covered by FEHBP plans. 'Drug costs have increased about 3 to 6 percent a year from 2004 to 2008, while specialty prescription drug costs increased 18 to 20 percent a year over the same period. Specialty drugs represented about 20 percent of total drug spending in 2008. The Health Industry Forum, Managing Specialty Pharmaceuticals: Balancing Access and Affordability, Conference Report (Washington, D.C.: 2008). 2For this report, enrollees refers to all individuals covered under FEHBP plans: federal employees, dependents, and retirees. GAO-09-517R FEHBP Coverage of Specialty Prescription Drugs

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