A practical report filled with strategies health plans are employing to effectively manage specialty drugs under the medical benefit using pharmacy benefit principles. Includes details about outcomes companies are seeing — and pitfalls to avoid — in implementing this approach to control skyrocketing specialty costs.
Industry estimates show that more than half of a health plan’s specialty costs fall on the medical side, yet plans traditionally have focused on managing only those drugs that fall on the pharmacy side. One tactic encouraged by PBMs is to shift specialty drugs from the medical side to the pharmacy benefit in order to easier manage them. But some payers are choosing to leave the drugs in the medical benefit and manage them there.
Managing Specialty Drugs Across the Medical and Pharmacy Benefits is a practical report filled with details of strategies health plans are employing to effectively manage specialty drugs under the medical benefit using pharmacy benefit principles. You’ll read about the outcomes being seen — and pitfalls to avoid — at companies like Blue Cross Blue Shield of Florida, RegenceRx, CVS Caremark and Express Scripts.
As plans consider a variety of strategies to control their skyrocketing specialty costs, Managing Specialty Drugs Across the Medical and Pharmacy Benefits will shed light on this approach that, if implemented correctly, can produce significant cost savings. Order today!
This book was written by the editorial staff of AIS, with contributions from: Beckie Fenrick, Pharm.D., M.B.A., senior director of clinical pharmacy programs at Blue Cross Blue Shield of Florida, Inc. (BCBSF); Lynn Nishida, R.Ph., director of clinical pharmacy services for RegenceRx, which is The Regence Group’s internal pharmacy benefit management service; and Debbie Stern, R.Ph., vice president of Rxperts, a managed care consulting firm in Irvine, Calif.
Pharmacy, clinical services and medical directors; strategic planners; product development, contracting and marketing executives; and financial and operations executives at
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