Cracking the Code: Unveiling the Data Insights for Managing Specialty Pharmacy Costs

As the costs of specialty drugs continue to rise, managing the expenses associated with specialty pharmacy has become increasingly challenging. In order to keep costs in check without compromising patient care, healthcare providers need to have access to the right data and analytics.

Fremont, CA: Prescription drug costs have been rising at a faster rate than other medical plan costs. Large employers have experienced prescription drug cost growth averaging 7 percent in recent years, with specialty drug costs increasing by 11.4 percent. In this scenario, employers need to explore ways to manage this growing cost. Here are a few things that employers can do to identify future opportunities to improve plan performance:

Analyze Drug Spend: Employers should analyze drug spend across both medical and pharmacy benefits and project how those costs may escalate over time. This could influence plan design decisions like excluding coverage under the medical plan for some drugs to steer members to a specialty pharmacy.

Re-evaluate Rebates: Employers must re-evaluate the financial value of specialty pharmacy rebates under the medical plan and negotiate contract language specifically focused on specialty medication.

Optimize Site of Care: Employers should know where plan members are receiving infusions and actively work with their PBM/carrier to drive distribution to the most efficient channels.