Managing Specialty Drugs Across the Medical and Pharmacy Benefits

Table of Contents

• Site-of-Care Optimization Can Reap Big Medical Benefit Savings
• Ensuring Appropriate Drug Use and Site of Service Could Be Improved
• Managing Specialty Pharmacy Medications Accessed Through the Medical Benefit: Challenges and Strategies
• Integrating Pharmacy and Medical Benefits
• Survey Shows Employers Need To Boost Specialty Knowledge
• Plans Boost Specialty Management, but Improvement Is Still Needed
• CVS Caremark Says It Will Manage Medical Benefit, Joins Other PBMs With Service
• Express Scripts Survey Takes Closer Look at Medical Specialty Spend
• PBMs Take Aim at Much-Needed Medical Benefit Drug Management
• New Express Scripts Unit Includes Medical Benefit Management
• Beyond Buy and Bill: Managing Specialty Therapies Under the Medical Benefit
• Fourth Tiers Could Generate Drug Savings or Increase Medical Spend
• Coverage of Oral, IV Oncology Drugs Can Hinder Compliance
• Location of Benefits Coverage for Eight Specialty Medication Classes
• Plans Look to Rein In Specialty Spend by Managing Medical Benefit

Written By

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.

Written For

Pharmacy, clinical services and medical directors; strategic planners; product development, contracting and marketing executives; and financial and operations executives at

• Health plans
• Specialty pharmacies
• PBMs and pharmacy benefit administrators
• Pharmaceutical manufacturers
• Employers
• Group-purchasing organizations
• Physician groups
• Infusion suites
• Consulting firms
• Disease management companies
• Third-party administrators

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• Read the Introduction to this report