Tag Archives: medical benefit

Lundbeck’s Vyepti Distributed by Only Two Specialty Pharmacies

Lundbeck has named AllianceRx and Orsini as the only two specialty pharmacies to distribute Vyepti

Insurers Using Site of Care Optimization to Reduce Specialty Drug Costs

Manufacturers are increasingly being affected by the commercial insurance market’s shift of medical coverage policies to lower-cost alternate sites

Will Diplomat Pharmacy Survive?

Diplomat found that competing successfully with large specialty pharmacies owned by Cigna/ESI, CVS Health/Caremark and UnitedHealth/OptumRx has been more difficult than projected

Diplomat Looking to Improve CastiaRx’s Performance

Diplomat has realized it needs to accelerate the implementation of its new payer sales strategy for CastiaRx

Pharmacy Benefit Manager Market Continues to Evolve

Pharmacy Benefit Manager Market Continues to Evolve. Recent consolidation in the pharmacy benefit manager (PBM) industry has resulted in major market share divided by the three market leaders: Express Scripts, CVS Health (Caremark), and OptumRx (UnitedHealth Group). PBMs remain searching for a value proposition beyond drug distribution with their employer clients. As long as PBMs […]

Designing Pharmacy and Medical Benefits for Cancer Care

Designing Pharmacy and Medical Benefits for Cancer Care: An Employer Perspective – published in Value-Based Cancer Care F. Randy Vogenberg, PhD, RPh, FASHP; Catherine E. Cooke, PharmD, BCPS October 2016, Vol 7, No 9 – Employers’ Perspective With the increasing complexity of cancer care after the passing of the 2010 Affordable Care Act, employers as […]

Employer Perspectives Specialty Drug Step-Therapy Program Evaluation

Employer Perspectives Specialty Drug Step-Therapy Program Evaluation American Health and Drug Benefits, September 2016 Vol 9, No 6 – Industry Trends Matthew Harman, PharmD, MPH, Director, Clinical Pharmacy Strategies Employers Health, Columbus, OH F. Randy Vogenberg, PhD, RPh, Strategic Advisor and Co–Project Leader, Midwest Business Group on Health National Employer Biologics & Specialty Drug Initiative […]

Specialty Drug Spend Under the Medical Benefit

Continuation in rising costs of specialty drugs and maybe accelerate in next 1-2 years: Randy Vogenberg

Specialty Drug Spend Under the Medical Benefit — 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 plan sponsors’ benefit design required of the payor. On average, up to 50% of specialty drugs are covered under the […]