Alternate Sites of Care — Infusible Drugs

This white paper briefly explores the commercial insurance market coverage policy shift to alternate sites of care (ASOCs), the underlying issues and resulting implication for key stakeholders around the use of biologic and infusion drugs. This white paper examines the financial risk from insurance decisions resulting in medical policy changes.

White Paper: Bend the Curve

A New Era for the Management of Specialty Pharmaceuticals

Biologic, biotechnology-based, rare disease, or high-cost pharmaceuticals — collectively known as specialty drugs — can be covered under the pharmacy benefit, the medical benefit, or both depending on the benefit design plan sponsors require of the third-party administrator (including the pharmacy benefit manager – PBM; administrative service organization – ASO; or any administrator of a medical or pharmacy benefit).

On average, up to 50% of specialty drugs today are covered under the medical benefit.

With the exception of a few key therapy areas, traditional tools used to manage specialty drugs under the medical benefit, such as prior authorizations and medical benefit carve-outs (i.e., “white-bagging”), have yielded limited value to plan sponsors.

This thought leadership analysis, with insights from recognized industry experts, will provide an overview of the challenges, a summary of the key issues plan sponsors must address and insights into best practices through an innovative new approach, Medical Benefit Drug Management (MBM).