Although American employers express concerns over the growing proportion of drug costs attributable to specialty medications—currently exceeding 30% and expected to increase to more than 50% in the next several years—a report finds that only 16% of employers devote more than 30% of pharmacy benefit management time to specialty drugs.
That’s according to the Pharmacy Benefit Management Institute’s 2014 Specialty Drug Benefit Report.
Both knowledge and use of common management tools are lagging in the medical benefit compared with the 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% to 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.
Additional key findings from the survey include the following:
- 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; and
- awareness of co-payment assistance programs is growing but not producing active management, especially among smaller employers.
The report includes responses from 337 employers covering an estimated 14.3 million enrollees.
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