Specialty drugs are prescription medications designed to treat complex, chronic conditions like cancer, HIV, skin conditions, and multiple sclerosis.1 These drugs can cost thousands of dollars per month and can significantly impact employers' healthcare costs. Here are a few ways employers can reduce specialty drug spending:
Formulary Management: This approach involves selecting the most cost-effective drugs for each condition and negotiating lower prices with manufacturers.
Negotiate rebates and discounts with PBMs: Employers can work with Pharmacy Benefit Managers (PBMs) to negotiate rebates and discounts on specialty drugs.
Encouraging the use of generic drugs: Employers can offer incentives to encourage employees to choose generic drugs over brand-name drugs in their health plans, such as lower copays or deductibles.
Mail-order Pharmacies for Specialty Drugs: Employers can encourage the use of mail-order pharmacies for specialty drugs that offer lower prices than traditional brick-and-mortar pharmacies.
Utilization Management Programs: These programs can help ensure that specialty drugs are only prescribed when medically necessary.It involves prior authorization requirements or step therapy protocols, where patients try lower-cost treatments before moving on to more expensive options.
Enroll in Medicare Plans: Employers can enroll their employees in Medicare Part D or Medicare Advantage plans, which can provide additional coverage for prescription drugs and reduce out-of-pocket costs for employees.
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Reducing specialty drug spend requires proactive management of costs.By working closely with PBMs, negotiating with pharmaceutical companies, and implementing utilization management programs, employers can reduce healthcare costs and provide more affordable healthcare options for their employees.