Large insurers are implementing policies requiring health care providers to get provider-administered therapies from specialty pharmacies
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 […]
Buy and Bill Trend: Are there Contradictions to Vendor or Pharma’s Reported Data Distribution based sales of specialty pharmaceuticals raises critical issues for manufacturers and providers as plan year 2016 decisions have been made and 2017 preparations begin by purchasers. For pharmaceutical manufacturers, the dilemma arises when (1) reimbursement is limited or eliminated under benefit […]