Edina, MN 55435
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 45-50% of total pharmacy spend, specialty is expected to grow by double digits annually.
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:
As a result, our clients are able to take a proactive approach to optimizing this complex and growing cost center.
“Your consultant should be as transparent as you expect your vendors to be”