Chronic inflammatory conditions like rheumatoid arthritis, psoriasis, and inflammatory bowel disease (IBD) are among the fastest-growing drivers of specialty drug spend. As prevalence rises, so does the demand for long-term, high-cost therapies — placing increasing pressure on payers to manage costs while improving outcomes.
Addressing these challenges requires a smarter approach to specialty trend – one that emphasizes clinical guidance, patient engagement, and reducing avoidable medical utilization. Emerging models that focus on tailored support for inflammatory conditions can help improve adherence and outcomes while also alleviating some of the financial strain across the health care system.
The cost burden of inflammatory conditions
More than 12 million Americans live with chronic inflammatory diseases, including:
These conditions not only impact quality of life—they also drive disproportionate specialty drug spend. The average cost per specialty prescription exceeds $4,500, and in IBD alone, 71% of health care costs are attributed to prescription drugs, primarily biologics.
But the true cost goes beyond the medication. Nonadherence and suboptimal treatment utilization often lead to flares, disease progression, and increased reliance on high-cost services like ER visits and hospitalizations. In fact, chronic conditions account for 90% of the nation’s $4.5 trillion in annual health care expenditures.
Medication adherence: A critical lever for payers
Medication nonadherence contributes to:
- 125,000 preventable deaths annually
- 25% of hospitalizations
- 50% of treatment failures
For patients with inflammatory conditions, staying on therapy is essential — not just for symptom control, but for avoiding costly complications. According to the CDC, improving adherence could save the U.S. health care system billions annually by reducing hospitalizations, ER visits, and treatment failures.
How integrated care models are transforming outcomes in inflammatory conditions & improving medication adherence
The complexity of inflammatory therapies continues to challenge traditional care models, making adherence a critical determinant of patient outcomes and overall health care costs. Leading organizations are demonstrating that integrated, patient-centric approaches — combining clinical expertise, digital engagement, and social support—are redefining what success looks like in specialty care.
Recent data reinforces this shift. Multi-modal engagement strategies have been linked to 12% fewer emergency room visits, 22% fewer inpatient admissions, and an 8% reduction in overall medical costs for payers. These results underscore a broader industry trend: adherence is not just a clinical issue but a behavioral and social one, requiring solutions that address the full spectrum of patient needs.
As the health care landscape evolves, models that integrate technology, personalized outreach, and equity-driven support are setting a new standard — one that prioritizes both improved outcomes and sustainable cost management.
A strategic opportunity for payers
As the inflammatory drug landscape continues to evolve, payers have a unique opportunity to bend the cost curve. But access to therapies alone isn’t enough. True value comes from ensuring patients are adherent, engaged, and supported throughout their journey.
Accredo’s RA&I TRC offers a scalable, outcomes-focused model that helps payers unlock greater value in inflammatory care — through stronger adherence, reduced utilization, and a better experience for members.
Explore how Accredo Specialty Pharmacy can help plan sponsors drive smarter specialty spend — starting with adherence.
DOWNLOAD WHITE PAPER
This article was created with the assistance of AI tools. It was reviewed, edited, and fact-checked by Evernorth's editorial team.
Accredo’s Therapeutic Resource Center (TRC) model has been central to the way we’ve practiced pharmacy for the past 20 years. Evernorth TRC Plus is a premium offering now available to plan sponsors navigating select high-spend specialty conditions like hemophilia and HAE. The offering leverages the power of our proven TRC model and connected management strategies to achieve more benefit predictability and lower costs.
