The $1 Million Prescription Problem: 10 High-Cost Medications Employers Should Be Watching
For years, employers have focused on trend percentages, renewal increases, and pharmacy rebates. But the real cost driver hiding in most self-funded plans isn't trend — it's a handful of specialty drugs that can each cost more than a million dollars a year.
VP of Employee Benefits · BHC Insurance · Independent Benefits Consultant
For years, employers have focused on trend percentages, renewal increases, and pharmacy rebates. While those metrics matter, they often distract from the real driver of pharmacy spending: a relatively small number of extremely expensive specialty medications.
Today, a single prescription can cost hundreds of thousands—or even millions—of dollars each year. Fortunately, many of these medications now have biosimilars or clinically appropriate lower-cost alternatives that can significantly reduce plan costs without sacrificing quality of care.
For employers sponsoring self-funded health plans, understanding where these opportunities exist has become an essential part of controlling healthcare costs.
1. Humira (Adalimumab)
For years, Humira was the highest-grossing prescription drug in the world. Used to treat rheumatoid arthritis, Crohn's disease, psoriasis, and other autoimmune conditions, annual costs frequently exceeded $80,000 per patient.
Today, numerous FDA-approved biosimilars are available, including Amjevita, Hadlima, Hyrimoz, Cyltezo, Simlandi, and others. Depending on contracting and PBM strategy, employers can reduce costs by 50% or more.
2. Stelara (Ustekinumab)
Stelara remains one of the largest drivers of specialty pharmacy spending for autoimmune diseases.
With biosimilars entering the market, employers now have opportunities to reduce costs substantially while maintaining comparable clinical outcomes.
3. Enbrel (Etanercept)
Although Enbrel has long faced patent litigation, lower-cost competitors continue to emerge globally, and future biosimilar availability is expected to create meaningful savings opportunities.
Plans should be preparing now for rapid adoption once broader market availability occurs.
4. Remicade (Infliximab)
Remicade has several well-established biosimilars already available, including Inflectra, Renflexis, Avsola, and others.
Many employers continue paying brand-name prices simply because utilization management has not been updated.
5. Rituxan (Rituximab)
Used extensively in oncology and autoimmune diseases, Rituxan has multiple biosimilars that often deliver significant savings with equivalent clinical performance.
6. Herceptin (Trastuzumab)
One of the most commonly used breast cancer therapies now has several FDA-approved biosimilars that can dramatically reduce oncology spending.
Cancer treatment represents one of the fastest-growing employer healthcare expenses, making biosimilar adoption especially important.
7. Avastin (Bevacizumab)
Another major oncology medication with multiple biosimilars available.
Employers should ensure oncology providers and specialty pharmacies are utilizing preferred lower-cost products whenever clinically appropriate.
8. Neulasta (Pegfilgrastim)
Several biosimilars now compete with Neulasta, helping reduce supportive cancer care costs while maintaining comparable patient outcomes.
9. Lantus (Insulin Glargine)
Although not technically a biosimilar in every market, interchangeable insulin alternatives have dramatically expanded.
Many employers continue paying unnecessarily high insulin prices because formularies have not been optimized.
10. Ozempic, Wegovy, and Mounjaro
GLP-1 medications have become one of the fastest-growing pharmacy expenses for employer health plans.
While true biosimilars are still several years away, lower-cost therapeutic alternatives, tighter utilization management, evidence-based prescribing criteria, and employer-specific coverage strategies can dramatically reduce unnecessary spending while preserving access for patients with the greatest clinical need.
The Bigger Opportunity
The availability of biosimilars does not automatically translate into savings.
Many employer health plans continue paying for brand-name medications because of outdated PBM contracts, rebate-driven formularies, provider prescribing habits, or a lack of specialty pharmacy oversight.
The highest-performing employer health plans are taking a much more proactive approach by:
- —Auditing specialty drug utilization
- —Reviewing PBM formulary decisions
- —Implementing biosimilar-first strategies
- —Optimizing specialty pharmacy contracting
- —Applying evidence-based utilization management
- —Monitoring high-cost claimants in real time
- —Holding vendors accountable for measurable savings
Final Thoughts
Pharmacy costs are no longer increasing because employees are filling more prescriptions. They're increasing because a relatively small number of specialty medications now account for a disproportionate share of total healthcare spending.
For many employers, replacing just a handful of high-cost brand medications with appropriate biosimilars or lower-cost therapeutic alternatives can save hundreds of thousands—and sometimes millions—of dollars annually.
The employers that will outperform over the next decade won't simply negotiate harder with their PBM. They'll build pharmacy strategies based on transparency, clinical evidence, and accountability.
That's where the real savings begin.
Questions about this topic? I'm available for consulting engagements across Northwest Arkansas and beyond.
Sources & Further Reading
- FDA — Biosimilar Product Information — FDA-approved biosimilars for Humira, Stelara, Remicade, Herceptin, and others
- FDA — Approved Cellular and Gene Therapy Products — Approved gene therapies including Zolgensma and Hemgenix
- CMS — National Health Expenditure Data — Prescription drug spending trends and specialty medication cost data
- KFF — Prescription Drug Cost Trends — Specialty drug spending trends and employer plan impact
- DOL — CAA PBM Transparency Requirements — CAA requirements for PBM drug cost disclosure to plan sponsors
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About the Author
Corry Hull, REBC®, CSFS®
VP of Employee Benefits · BHC Insurance
Corry Hull, REBC® CSFS®, is VP of Employee Benefits at BHC Insurance and the founder of Employer Benefits IQ (www.employerbenefitsiq.com). He is a Certified Health Rosetta Advisor — one of fewer than 200 nationwide — and a multi-year presenter at United Benefit Advisors (UBA) national conferences. He specializes in self-funded health plan design, PBM contract strategy, stop-loss structuring, group medical captives, and ACA/ERISA compliance for mid-market employers. His work has been recognized by Health Rosetta (Rosie Award, 2026), UBA (Producer Peak Performer, 2025–2024), and BHC Insurance (Producer of the Year, 2021–2025). His employer-education content has been referenced in BenefitsPro and cited within the Health Rosetta advisor community. All consulting and brokerage compensation is fully disclosed.