Sharply rising expenditures for cancer drugs and other high-priced meds are prompting employers, health plans and pharmacy-benefit managers to redouble efforts to rein in spending, The Wall Street Journal writes. To curb use, payers are pushing for legislation to permit generic drugmakers to sell cheaper versions of biologics, reinforcing rules about trying cheaper therapies first, and early certification of patient prescriptions. Some seek novel solutions such as paying drugmakers based on how well a drug works, rather than how much is used.

The actions come amid fresh evidence that so-called specialty pharmaceuticals are among the biggest drivers of escalating health costs. Express Scripts, the pharmacy-benefits manager, says a report due out next months shows that spending for these drugs jumped 14 percent last year, down from 21 percent. And Medco Health Solutions, another PBM, says its preliminary figures show spending rose between 12 percent and 14 percent.

What’s more, specialty-drug spending in the US could reach $99 billion by 2010, nearly double the $54 billion spent in 2006, Steve Miller, chief medical officer at Express Scripts, tells the Journal. Why? The average prescription for these meds costs more than $1,500 and some top $100,000 a year. By contrast, conventional brand-name pills for problems such as high blood pressure, high cholesterol, and depression run roughly $90 to $120 a month.

To cope, Aetna is exploring a “pay-for-performance” strategy in which drug price is tied to efficacy. “Some people have spectacular results” taking biotech drugs while “others have no results,” Edmund Pezalla, national medical director of Aetna Pharmacy Management, tells the paper. The idea is to negotiate prices based on whether a patient responds to a treatment. Some companies provide rebates in cash for product if patients don’t achieve the desired therapeutic benefit. “We’ve gotten some preliminary feedback and companies are willing to discuss this,” he says. “We’re looking at data, they’re looking at data. Hopefully we’ll come up with an arrangement with at least one pharmaceutical firm that will pave the way for this.”