Specialty Drug Costs to Rise 32% by 2028: Utilisation Drives Spend

What happened

Specialty drug expenditure in the United States is forecast to rise by 32% by 2028, according to new research from PSG (Pharmaceutical Strategies Group). The firm's findings, reported by HR Executive, point to a structural shift in what is driving that cost curve: it is no longer simply the price of individual drugs, but the sheer volume of people using them.

PSG identifies claim utilisation as the dominant force behind the specialty drug trend. The share of health-plan members using at least one specialty medication has climbed to 5.5% — a relatively small slice of any workforce population that nonetheless accounts for a disproportionate share of total pharmacy spend. As more conditions gain approved specialty-drug therapies and prescribing broadens, that utilisation pressure is expected to intensify through the remainder of the decade.

Why it matters

For employers, benefits administrators and the insurers who design health products around them, this forecast reframes the problem. When price inflation was the primary driver, the lever was negotiation — rebates, formulary controls, pharmacy benefit manager contracts. When utilisation is the driver, the lever shifts to care navigation, member engagement and behavioural support: helping the right people access the right therapy at the right time, while steering others away from unnecessary or duplicative use. That is fundamentally a customer-experience and service-design challenge, not merely a procurement one.

From a behavioural-economics perspective, rising utilisation also reflects well-documented dynamics around availability bias and defaults. As specialty drugs become more visible — through direct-to-consumer advertising, expanded clinical guidelines and digital health platforms — the perceived accessibility of these treatments changes, nudging both clinicians and patients toward prescribing and requesting them. Benefit designers who ignore the behavioural architecture of how members discover and choose treatments will find cost-containment strategies falling short.

By the numbers

• 32% — projected increase in specialty drug costs by 2028, per PSG.
• 5.5% — share of health-plan members currently using specialty drugs, now identified as the primary trend driver.

The Renascence take

Most commentary on this forecast will focus on pharmacy benefit redesign and formulary tightening. That misses the deeper lever: the member journey itself. How a health plan communicates, educates and guides its members through a specialty-drug decision is as consequential as any rebate negotiation.

The real design failure here is treating specialty drug access as a purely clinical or financial transaction. When utilisation is the dominant cost driver, the experience of the member — how they are informed, supported and navigated through complex therapy choices — becomes a direct cost variable. A customer-obsessed benefits operator should audit the moments of truth in the specialty-drug journey: the point of diagnosis, the prior-authorisation interaction, the first-fill experience. Friction in the wrong place delays necessary care; absence of friction in the wrong place accelerates unnecessary spend. Precision in experience design is the discipline that closes that gap.