Less than 20% of plan sponsors are capable of tracking their specialty drug spend, according to a survey by the U.S.-based Pharmacy Benefit Management Institute (PBMI). The study surveyed 291 U.S. employers, health plans and other plan sponsors.
“Our study shows that specialty spend under the medical benefit all too frequently goes unmeasured and unmanaged,” said Brenda Motheral, executive director of PBMI. “Given that 50% or more of specialty spend can reside in the medical benefit, closing this gap is a critical priority for plan sponsors.”
Specialty drug spend is expected to continue to grow for the next several years, yet, the current level of understanding of specialty pharmacy benefits management is low among plan sponsors, says PBMI. Of those surveyed, only 19% of employers and 33% of health plan administrators said they have a high knowledge of the subject.
The variability between cost-sharing structures for pharmacy and medical benefits is significant, which can disincentivize patients from using the most cost-effective benefits channel. Under the medical benefit, 29% of employers cite “no cost sharing” as the most common specialty cost share design, whereas co-pays are the most common design for employers under the pharmacy benefit.