Public Resources

As the exorbitant cost of specialty drugs continues to dominate healthcare news, most employers are scrutinizing their pharmacy benefit manager (PBM) practices. Still, many purchasers are surprised to learn that nearly 50% of a plan’s total drug spend comes from specialty medications and about 35% of those are currently bill through the medical benefit. This matters because drugs reimbursed through the medical benefit include unhelpful J codes, which are much less specific than NDC codes, obscuring the true cost of specialty drugs and healthcare associated with administering them. Learn more about this and other opportunities to achieve value on the medical side of drug benefits in this report.