Specialty Drug Management
Managing one of the largest hidden costs of medical care.
Specialty pharmacy cost is a growing concern for most healthcare payers. While specialty pharmacy often falls within PBM administration, it is estimated that nearly 50% of the total cost is embedded within the medical spend. Current market conditions illustrate lower than expected pharmacy trends, but it is specialty pharmacy that is largely driving total pharmacy costs and utilization increases. Currently averaging 35-40% of total pharmacy spend, specialty is expected to grow to 50% of overall pharmacy expense by 2020.
While the pure ingredient cost of specialty pharmacy is certainly a concern, the clinical programs surrounding specialty pharmacy are more relevant than ever. We help clients develop a program that will maximize patient service levels while maintaining a fiscal responsibility to the plan. The results of a successful program include lower baseline costs, increased member compliance, reduced admissions and overall improvement of the medical loss ratio.
Our team assists clients in developing:
- Specialty pharmacy strategy, including formulary guidance;
- Step therapy programs;
- Vendor selection and contract negotiation;
- Network evaluation;
- Prior authorization criteria and process;
- Overall clinical and trend management programs;
- Specialty only procurement
As a result, our clients are able to take a proactive approach to optimizing this complex and growing cost center.