The Bridges Initiative in action: Making high-cost specialty drugs more affordable and accessible

The challenge

Expensive “specialty drugs” in the U.S. are major contributors to escalating costs for health-care systems, employers and patients alike. Specialty drugs are relatively new drugs that target specific, complex and chronic conditions such as multiple-sclerosis, rheumatoid arthritis and hepatitis C¹. While these exciting modern therapies offer patients with debilitating conditions the possibility of improved condition management, the drugs often come with significantly higher price tags than traditional drugs. 

Specialty drugs can have a huge impact on costs within group benefits plans. This reality is underscored in self-funded plans, where employers pay their own medical claims and typically incur a 250-300% markup on specialty drugs when administered in the hospital setting. According to KFF, an independent non-profit organization focused on national health issues, 65% of covered workers in the U.S. are in a self-funded plan².

The product

Sun Life manages high-dollar medical claims for more than 2,800 self-funded employers covering more than nine million people, and we listen to our Clients’ concerns about the importance of tackling two pressing issues that relate to specialty drugs – access and affordability.

In July 2023, Sun Life U.S. launched a program with OptiMed Health Partners to make specialty drugs more affordable and accessible. The solution, Medical RX 360 powered by OptiMed, identifies opportunities to administer specialty drugs to members who need them-in a convenient setting, such as the member's home or an infusion center - working in concert with the member's physician and care team. 

This type of highly coordinated and personalized delivery system reduces the risk of infections and complications for patients, while decreasing treatment expenses for high-cost specialty drugs. At no additional cost to the Client, OptiMed's vast experience in effectively managing specialty medication trends helps those who self-fund their health plans better manage their health-care costs. 

"As therapeutic advancements continue, it is essential for plans to lean on industry experts and partnerships such as this, to promote sustainability and high levels of clinical support to members when they need it most." 

Rusti Greis, Vice President, Business Development for OptiMed Health Partners

The impact

• Medical RX 360 improves access to specialty drugs and reduces costs for self-funded health plans, tackling the issue of escalating health-care expenses that impact employers.
• The product has been accessed by over 8,500 members and has achieved savings of US$1.89 million since launch³.

¹ Sun Life. “High-cost claims and injectable drug trends analysis”. 2023.
² KFF. “2022 Employer Health Benefits Survey”. 2022.
³ As of December 31, 2024.