A new study by U.S.-based Pharmacy Benefit Management Institute’s (PDMI) has found that American employers offering drug coverage need to take a look at how their specialty drugs are being managed.
Only 49% of employers report having prior authorization programs for specialty drugs under the medical benefit, but 84% of employers have these programs under the pharmacy benefit.
Also, 25% of plans report having no cost sharing for specialty medications under the medical benefit, and fewer than 20% are receiving rebates under medical, compared with 69% under pharmacy.
“At the core of this management gap is employers’ lack of visibility into the medical spend. Fewer than one in four employers reported being able to track specialty spend under the medical benefit, which is the foundation for active management,” says Brenda Motheral, executive director of PBMI.
Other key findings include the following:
- 44% of employers now have a separate co-pay tier for specialty drugs, up from 36% a year ago;
- knowledge of specialty drug management remains low, with 11% of employers self-reporting a low level of understanding, 70% a moderate level and 19% a high level; and
- among small employers, 38% were unsure if they received specialty rebates under pharmacy.
The report is based on survey respondents from 306 U.S. employers, health plans and other plan sponsors, representing an estimated 17.6 million lives.