Prescription drug spending is one of the fastest growing drivers of health care costs, doubling over the past 10 years as a percent of overall health care dollars.While total utilization of prescription drugs has remained constant, the escalation of costs is largely due to a shift to high-cost brands and specialty medications that are increasingly prescribed by doctors. These advanced medications are used to treat complex or rare chronic conditions, such as cancer, rheumatoid arthritis, hemophilia, psoriasis, inflammatory bowel disease, and hepatitis C. Drugs such as Humira, Stelara, Keytruda, and others have also become some of the most heavily advertised drugs.While such high-cost specialty drugs are a small portion of the total of all drugs dispensed, they represent a disproportionate and growing share of total drug spending. Specialty medication spend accounts for 41% of plans' total pharmacy spend and is estimated to approach 50% by the end of 2020.[1]