Specialty drugs now represent more than 50% of total drug spending across pharmacy and medical benefits combined, despite being used by a small percentage of members. Many high-cost infused and provider-administered therapies are still billed through the medical benefit, where pricing transparency and utilization controls are often limited.
By strategically shifting appropriate specialty medications from the medical benefit to the pharmacy benefit, plan sponsors can gain greater visibility, access site-of-care optimization, leverage specialty pharmacy management programs, and take advantage of biosimilar opportunities. This can save plan sponsors upwards of 40% per claim.
At ProAct, we've seen how an integrated specialty strategy can help employers better manage trend while maintaining quality care and a positive member experience. Industry data shows specialty drugs now represent approximately 52% of total non-discounted drug spend, making proactive management more important than ever.
