How Specialty Drug ‘Solution Stacking’ Can Rein in Pharmacy Benefit Costs

Brokers and employer groups alike know that 5% to 10% percent of insured workers and their dependents drive 50% to 60% of the cost of pharmacy claims. A few members with prescriptions for a specialty drug with a five-figure price tag can easily represent the majority of an entire group’s pharmacy spend. 

These drugs are often life-saving or provide a dramatic quality of life improvement for those who take them. No one would question the necessity of using them. But when a group can mitigate some of the cost without affecting the clinical outcome, it can be a game changer. The broker who unlocks these savings becomes a trusted ally. 

Typically, plan sponsors believe they don’t have many options for specialty drug claims and simply end up paying them. But that’s not the case. When one solution doesn’t work, there are likely several more options to try. A little ingenuity can make a significant impact on drug spend and trends. This is a technique I describe as “solution stacking,” which cycles through multiple specialty drug programs and often leads to a major cost reduction. Here’s how solution stacking works… 

See the full article by AlignRx President Kobielski on InsuranceNewsNet.