With specialty drug costs rising out of control, it is important to know how to design a cost-effective, yet high-quality plan for your employees.
Read on for National CooperativeRx’s recommendations to make sure you are getting the most out of your benefit dollars.
In 2023, specialty drugs among National CooperativeRx membership accounted for 1.5% of claims, yet 47% of total pharmacy spend.
What Is So Special About Specialty Drugs?
Since there is no industry standard definition for specialty drugs, the drugs included on a specialty drug list will vary between vendors. However, specialty drugs will typically share several common characteristics:
- Very expensive price tag.
- Primarily used to treat complex and chronic conditions.
- Requires special handling and administration.
Push Your Savings To The Max
It is crucial that employers design a quality and affordable specialty drug benefit plan with multiple approaches.
To accomplish this:
- Work with a specialty network.
- Limit prescription refills to one fill or one month’s supply to minimize potential waste.
- Leverage your PBM’s formulary or preferred drug strategies.
Rebates
Make sure your organization is receiving 100% of specialty rebates. The financial significance of rebates is great when it comes to specialty drugs, because drug makers pay PBMs billions of dollars in rebates each year. Large employers are more likely than small employers to receive the entire rebate amount for specialty drugs.
The Final Word
A sound plan designed specifically for your group is key to drive performance and favorable outcomes. Partner with someone you trust who can provide solid recommendations, plan oversight and support on your behalf while still advocating for the health of your plan participants.
Sources
- Santye, Lauren. “Specialty Pharmacy Drugs: 2016 Approvals and 2017 Forecasts.” Specialty Pharmacy Times. Specialty Pharmacy Times, 26 Jan. 2017. Web. 7 June 2017
