Employers Overwhelmingly Satisfied with PBMs’ Specialty Pharmacy Services

Employers understand the critical role of specialty pharmacies and how pharmacy benefit managers (PBMs) make those services possible. A recent survey of more than 1,000 small and large employers found that employers strongly value specialty pharmacy services as part of their contracts with PBMs.

• 98% of employers stated that when choosing a PBM, specialty pharmacy services for managing complex, high-cost medications are an important factor in their decision-making​.
• Employers are overwhelmingly pleased when it comes to specialty pharmacies, with more than 9 in 10 employers satisfied with their PBMs’ specialty services.

Specialty Pharmacies and Chronic Conditions

Conditions like cancer can be tragic and deeply challenging to treat; they also represent a significant cost burden to those impacted. Increasingly, these chronic conditions demand complex therapies, known as specialty drugs. Specialty medications are often extremely sensitive, necessitating clinical expertise to administer and specialized storage and transporting.

While only 2-3% of prescriptions filled are for specialty drugs, they account for over half of all drug spending. Employers, government programs, and patients spent over $100 billion on specialty oncology medications alone in one year.

Retail and community pharmacies are often not able to store, handle, and advise patients on these complex drugs. One medication, for example, must be stored at nearly negative 100 degrees to prevent degrading and loss of efficacy. It is the aptly called specialty pharmacies that help patients access these drugs safely and effectively.

Some specialty pharmacies are affiliated with PBMs, and all PBMs work closely with specialty pharmacies to ensure patients receive their specialty drugs and the clinical care they need.

These pharmacies fill an important role for patients, according to a clinical expert at one specialty pharmacy:

“Our specialty pharmacy is unique because we work with patients on complex, chronic, and often life-altering conditions such as autoimmune disorders, cancer, asthma, hepatitis, and rare diseases to name a few. Unlike retail, where the focus is primarily on dispensing, the specialty pharmacy requires close coordination with providers, insurance, prior authorizations, drug access programs, and ongoing clinical oversight. Many of our patients depend on medications that are not available at traditional pharmacies, require specialty handling/storage, and come with significant financial barriers.”

Taken together, employer satisfaction and patient need underscore the essential role that PBMs and specialty pharmacies play in improving care while helping manage the most challenging and costly treatments for patients.

Learn more about how PBMs are supporting the employers who hire them HERE.