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).
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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).