This annual report, presented by Pharmaceutical Strategies Group, details specialty drug benefit designs and trends and provides a comprehensive look at specialty drug benefit management.
Designing drug benefits that provide patients with cost-effective access to needed specialty drugs while maintaining an affordable benefit is highly complex.
Payers’ top goals remain unchanged despite market shifts
Even as many dynamics in the specialty market are evolving, managing overall specialty drug spend and total cost of care continue to be payers' leading strategic goals for specialty drug management.
Payers are increasingly open to exchanging rebates for tighter utilization management
Interest in accepting lower rebate guarantees in exchange for the ability to implement more utilization management controls is increasing, and many payers value such control over rebates.
Coverage of expanded indications and new product launches now top payer challenge
The rapid growth of new specialty drugs and expanded FDA indications has increased pressure to adapt coverage strategies quickly and effectively.
Payers see limited differentiation among specialty pharmacies
While most payers rate the clinical and care management support provided by specialty pharmacies as good, only 1 in 5 assign the highest rating, and they tend to see only moderate differentiation in patient care across specialty pharmacies.
Cross-benefit specialty formulary optimization is gaining momentum
Payers' focus on optimizing their formulary strategy across pharmacy and medical benefits is increasing, and many have processes to manage their specialty formulary across benefits.
