Managing Specialty Drugs Under the Medical Benefit: Each year, there are an increasing number of biologics and specialty drugs produced for a number of rare and chronic conditions.
With more of these drugs coming down the pipeline, and faster drug approvals, payors and plan sponsors continue to seek effective management strategies that support the health and productivity of their workforce, drive optimal patient outcomes, address data transparency issues and positively impact the bottom line.
AMI’s new report, Managing Specialty Drugs Under the Medical Benefit, looks at specialty drugs billed through the Medical Benefit.
Employers work to develop effective benefit design strategies that support the health and productivity of their workforce, drive optimal patient outcomes, address transparency issues from third-party program administrators and positively impact the bottom line.
A main challenge for employers is identifying what costs relate to the medical benefit versus the pharmacy benefit. With a high percentage of costs occurring through medical benefits, as well as a variety of payment and dispensing options, it can be difficult to achieve full transparency on overall spending and utilization. The gaps in benefit administration alignment within or across vendors makes this objective even more challenging.
Managing Specialty Drugs Under the Medical Benefit report’s Table of Contents:
Today’s Specialty Marketplace – pgs. 4-7
Medical vs. Pharmacy Benefit Coverage – pgs. 8-14
- CVS Health NovoLogix – pgs. 15-16
- Express Scripts Care Continuum – pgs. 17-18
- Magellan Rx Management – pgs. 19-20
- PharMedQuest – pgs. 21-22
References – pg. 23
- Spending on Specialty Pharmaceuticals – pg. 6
- Hospital/Health System Likelihood Specialty Drug Use – pg. 7
- Key Differences Pharmacy Medical Benefit Billed Drugs – pg. 9
- MCO Mix Cancer Spending Growth Rates by Benefit – pg. 10
- Projected Specialty Medication Spending PMPM-Top 10 Therapeutic Classes – pg. 12
- Level of Employer Understanding of Specialty Drugs – pg. 13
- Employer Value of Specialty Drugs – pg. 14
Published: December 2016