Twenty-five percent of employers say they have little or no understanding of specialty pharmacy benefits while 53 percent say they have just a moderate understanding, according to a recent survey by the nonprofit Midwest Business Group on Health.
Of the 120 surveyed employers, which vary in size from 500 to 25,000 employees, most say they don't know how much is being spent on specialty pharmacy medications through their medical or pharmacy plans. Nearly 30 percent say they're unaware of how much their total specialty claim costs had increased over the last three to five years.
"In addition to the uncertainty and challenges that health reform and the economy are placing on employers, health plans and pharmacy benefit managers, the real driver of drug cost trend growth for employers lies in biologics and specialty pharmacy," says Cheryl Larson, MBGH vice president. "Our research confirms there is a broad lack of awareness and specific knowledge about benefit design related to specialty pharmacy that illustrates key gaps that need to be addressed."
Recommended For You
The survey also finds that most employers still follow a traditional benefit design, which includes tiered formularies, copayments and coinsurance for specialty drugs, rather than value-based or innovative benefit designs that could be better for biologic and specialty pharmacy medications. Respondents say vendor costs are the most important criteria for contracting with a specialty pharmacy.
According to the survey, 42 percent of respondents use PBMs to manage their specialty benefit, 22 percent of respondents use their health plans, and 18 percent of respondents use both. Of the respondents, only 13 percent cite using a specialty pharmacy provider. Seventy-six percent of respondents have no employee incentive to encourage proper medication compliance and adherence to treatment for both biologic and specialty medications.
© 2025 ALM Global, LLC, All Rights Reserved. Request academic re-use from www.copyright.com. All other uses, submit a request to [email protected]. For more information visit Asset & Logo Licensing.
