Within current specialty plan designs, 35% of employers surveyed are using tiers, coinsurance and copays
As plan sponsors seek to control spending on specialty drugs, they are discovering that passive strategies are no longer an option.
According to the not-for-profit Midwest Business Group on Health (MBGH), more employers consider themselves to have “above average” understanding of the specialty pharmacy space, 49% in 2012, compared to just 22% in 2011. For some, specialty drugs can account for as much as 40% of total pharmacy spend.
Within current specialty plan designs, 35% of employers surveyed are using tiers, coinsurance and copays. Only 21% use specialty tiers with cost sharing, which underscores the need for benefit design innovation, according to MBGH. Case management, drug utilization and cost sharing are the top three priorities for managing specialty pharmacy benefits.
However, employers should also seek a specialty pharmacy that suits their needs.
A whitepaper released by Avella Specialty Pharmacy in March lists 10 evaluation measures.
With 1,200 new drugs in the pipeline-many expected to be specialty drugs-sponsors should be prepared for steep trends in the future.