Although employers are more focused on specialty drug management than in the past, they are still relying on third-party vendors to manage this challenging benefit. This is of significant concern given the PBM price transparency issues and ongoing cost increases from the middleman (e.g. PBM, health plan, distributor, wholesaler).
Employers must identify and implement new financial risk models and health management strategies specific to specialty drugs to get the most value for their health care dollar. This might require re-evaluating their entire benefit design strategy to determine where gaps exist in plan performance and clinical outcomes. Download a pdf of the Employer Checklist for Designing Specialty Drug Benefits to get started.
Most employers recognize the importance of implementing key tactics to effectively manage specialty drug costs. MBGH Survey results cited the 5 top cost and patient outcomes strategies as follows: