November 21, 2016
An analysis from Visante quantifying how PBMs generate $6 in savings for each $1 spent on their services. Major Findings...
Complex, innovative, and high-priced specialty drugs are entering the U.S. health care market at a rapid rate. In many cases, these specialty drugs offer the most effective—and in some cases, the only—treatment for illnesses and conditions that historically had few treatment options. Given their complexity, these drugs often require active clinical management, considerable patient education, and sophisticated logistical support for special administration, monitoring, and handling requirements. Patients taking a specialty drug often rely on enhanced clinical services to ensure safe use of the drug and optimize therapeutic outcomes.
Payers, providers, and patients have growing concerns with the cost and utilization of expensive specialty drugs. To address these challenges, payers rely on PBMs to manage the use of and payment for specialty drugs. PBMs offer techniques, including the use of specialty pharmacies, to improve the quality and continuity of care that patients receive, while also addressing overall costs.
Over the next ten years, PBMs and specialty pharmacies will save payers and patients an estimated total of $250 billion on the cost of specialty medications and related non-drug medical costs when compared to what expenditures would be with limited use of PBMs and specialty pharmacies. PBM tools that have been used for years in the small-molecule drug categories to control costs are continuing to be successfully leveraged in the specialty drug category. The continued use of these cost-saving tools will be essential as PBMs and payers work to manage expenses and enable access to these innovative drugs.
February 04, 2016
Pharmacy Benefit Managers (PBMs) now implement prescription drug benefits for some 266 million Americans who have health insurance from a...
October 17, 2017
PCMA President and CEO Mark Merritt Testifies Before Senate HELP Committee Testifying today before the U.S. Senate Committee on Health,...
August 24, 2017
“Insurers are Still Denying Treatments for Pre-Existing Conditions” perfectly reflects the drug lobby’s criticism of the clinical safeguards used to...
August 08, 2017
(Washington, D.C.) — As the Administration puts forward new steps to curb the rising opioid epidemic, the Pharmaceutical Care Management...
September 01, 2016
Despite ongoing price inflation and an increase in utilization, prescription drug trend dropped for a majority of CVS Health pharmacy...
June 27, 2016
Bloomberg Businessweek — OptumRx was doing a routine analysis of a client’s prescription-drug claims when it noticed something odd. The...
What is a specialty pharmacy?
Specialty pharmacies were established in direct response to the industry’s need to better procure, store, and dispense specialty drugs, as well as better manage therapy for patients on specialty drugs.
What is a specialty drug?
Specialty drugs are best defined by the full range of each product’s attributes, rather than solely by cost and route of administration.
What services do specialty pharmacies provide?
Specialty pharmacy services are designed for a small, but growing population of patients with relatively complex and chronic diseases that require expensive and challenging drug regimens.
Specialty Drug Trends
Complex, innovative, and high-priced specialty drugs are entering the United States health care market at a rapid rate.