Employer Concerns About Specialty Drug Cost Not Reflected in Management Activities

PLANO, TX--(Marketwired - Feb 10, 2014) - Although employers express concerns over the growing proportion of drug cost attributable to specialty medications, currently exceeding 30% and expected to increase to more than 50% in the next several years, only 16% devote more than 30% of pharmacy benefit management time to specialty drugs. This is just one of the key results from the 2014 Specialty Drug Benefit Report released by the Pharmacy Benefit Management Institute. The report, sponsored by Walgreens Specialty Pharmacy, includes responses from 337 employers covering an estimated 14.3 million enrollees.

This is the third year that PBMI has conducted a specialty drug management survey. "We modify the survey annually to address clinical and marketplace changes," explained Kathleen Fairman, PBMI's Vice President of Research and Education. "Both the therapeutic potential and the challenges associated with specialty medications are growing rapidly, and the report reflects that growth." This year's survey included new questions about management strategies for the medical benefit, provider network development, anticipated effects of biosimilars, and opinions about retail and specialty pharmacies.

Additional key findings from the survey, which was conducted in September 2013, include:

• Both knowledge and use of common management tools are lagging in the medical compared with pharmacy benefit.
  • When asked to rate their understanding of specialty drug management, only 7% give themselves a low knowledge rating for the pharmacy benefit, compared with 30% for the medical benefit.
  • Tools such as prior authorization, formularies, and step therapy are now mainstream in the pharmacy benefit, used by 74%-90% of employers. However, use rates for these tools are 20 to 40 percentage points lower in the medical than pharmacy benefit and represent a major growth opportunity for plan sponsors.
• Restricted provider networks are commonplace for specialty medications; over the next year, only 8% plan to increase access through a retail pharmacy, and 29% plan to decrease access at retail.
• Awareness of copayment assistance programs is growing but not producing active management, especially among smaller employers.

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About PBMI
The mission of the Pharmacy Benefit Management Institute (PBMI) is to create the industry's premier forum for health care purchasers to exchange ideas, advance best practices and drive appropriate changes in the pharmacy benefit management marketplace.