Better Managing Your Specialty Drug Benefits

Many employers misunderstand specialty drugs and the costs associated with them. According to a national survey by Midwest Business Group on Health (MBGH), one-quarter of employers in the United States (representing private and public employers) have little to no understanding of specialty pharmacy benefits. Additionally, only 53 percent have a moderate understanding of what specialty pharmacy benefits are.

What are specialty drugs? Specialty drugs are highly complex prescription medications that require special handling, administration, or monitoring.  These drugs are used to treat complex, chronic and often costly conditions, including asthma, cancer, chronic kidney failure, Hepatitis C, HIV/AIDS, organ transplants, psoriasis, rheumatoid arthritis, infertility and much more.

Most employers are using a traditional benefit design, including tiered formularies, co-payments and co-insurance, but tiered drug benefit plans may provide a different level of coverage for specialty drugs. And unfortunately, employers may not be aware of just how much money is being spent on these drugs.

A value-based benefits design might be a better fit for employees with biologic/specialty pharmacy medication needs. The survey conducted by Midwest Business Group on Health revealed that only 13 percent of employers were using a specialty pharmacy provider, a provider that may have greater expertise on how to provide these drugs more effectively.

Even with the high costs associated with specialty drugs, insurer competition remains a factor in pricing and PEO Advantage has wholesale access to over 100 nationwide PEOs and all major medical and supplemental insurance carriers. PEO Advantage guarantees its clients a minimum of 25% cost reduction.

Vendor cost is often one of the most important criteria employers consider when contracting with a health care provider, and value-based designs are still capable of lowering, rather than increasing, co-pays for specialty drugs deemed necessary for patient treatment. They may also provide health coaching, to ensure compliance with medical regimens and encourage the proper use of these drugs.

For more information on value-based designs and healthcare/prescription coverage, contact PEO Advantage. Our streamlined yet comprehensive process includes in-depth analysis, a proprietary reverse auction RFP process, easy-to-read reports, side-by-side comparisons that clearly show value and savings, cost projections and expert recommendations. We take all the guesswork and hassle out of choosing the best healthcare options for your company.

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