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Compliance issues should guide your decision on whether a drug or drug class or even all specialty drugs should be excluded from your plan.

The cost of pharmaceuticals is forcing employers into a balancing act that’s increasingly hard to maintain these days, making them straddle the line between compassion and their fiscal and legal responsibilities as high-cost drug claims continue to mount.

The pressure on drug costs has only intensified in recent years with specialty drugs that save or extend lives but carry breathtakingly high price tags. Think Zolgenzma, which treats children with deadly spinal muscular atrophy–at a cool $2.125 million. These drugs add to the burden of overall prices that are expected to rise 6.3 percent annually over the next decade. Even before the specialty drug phenomena, prescription costs have taken up a fast-growing and outsized portion of total premiums, reaching 16.5 percent by 2016 from 12.8 percent in 2012.

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