SOURCE: Pharmacy Benefit Management Institute

Pharmacy Benefit Management Institute

February 19, 2013 08:30 ET

PBMI Survey Finds That Specialty Drug Management Under the Medical Benefit Is Lacking for Employers

PLANO, TX--(Marketwire - Feb 19, 2013) - The new PBMI Specialty Drug Benefit report finds that the management of specialty drugs under the medical benefit still trails management under the pharmacy benefit. Only 49% of employers report having prior authorization programs for specialty drugs under the medical benefit, compared to 84% under the pharmacy benefit. One-quarter of plans report having no cost share for specialty medications under the medical benefit, and less than 20% are receiving rebates under medical, compared to 69% under pharmacy.

"At the core of this management gap is employers' lack of visibility into the medical spend. Less than 1 in 4 employers reported being able to track specialty spend under the medical benefit, which is the foundation for active management," says Brenda Motheral, PhD, Executive Director of PBMI.

This is just one of the key findings of the 2013 Specialty Drug Benefit Report sponsored by Walgreens Specialty Pharmacy (Walgreens). This is the second year that the Pharmacy Benefit Management Institute (PBMI) has published this report. 

Over 300 employers representing 17.6 million members completed the survey. New to this year's report is the addition of questions addressing optimal site of care for specialty drugs as well as survey results broken out by larger and smaller employers. Other key findings include:

  • More active management was observed for specialty drugs covered under the pharmacy benefit.
    • 44% of employers now have a separate copay tier for specialty drugs, up from 36% a year ago.
    • Step therapy adoption under the pharmacy benefit grew from 61% to 58% of employers.
    • Employers who limit specialty quantities to a 30-day supply grew from 58% to 67%.
  • Knowledge of specialty drug management remains low.
    • 11% of employers self-reported a low level of understanding, 70% moderate, and 19% high.
    • Among small employers, 38% were unsure if they received specialty rebates under pharmacy.
    • Nearly 40% of respondents are not sure which site of care has the lowest cost under the medical benefit.
    • Employers report the greatest interest in learning more about specialty medical management and specialty copay assistance programs.

PBMI gratefully acknowledges the support of Walgreens Specialty Pharmacy (Walgreens) for the sponsorship of this report. Walgreens has no access to the individual responses or raw data gathered, nor do any other third parties. This protects the confidentiality of the survey respondents and ensures the independence and objectivity of this report.

About The Pharmacy Benefit Management Institute (PBMI)

PBMI provides research and continuing education to help health care purchasers work effectively with pharmacy benefit managers and other industry professionals to improve pharmacy benefit programs and control costs.

Contact Information

  • Contact:
    Brenda Motheral, BPharm, MBA, PhD
    Executive Director
    Pharmacy Benefit Management Institute
    Email: Email Contact