Nearly three-quarters (74%) of employers offered a specialty pharmacy benefit in 2011, but 18% of employers did not know if they offered a specialty pharmacy benefit. In 2011, 48% of respondents required that specialty drugs be filled through the PBM's designated specialty pharmacies, an eight percentage point increase from 2010. Thirty percent used their PBM as their exclusive supplier of specialty drugs. Nearly one in four (24%) now restrict coverage of specialty in their medical plan in order to channel specialty drugs to the PBM. Use of the PBM as the exclusive supplier was more common among employers with 20,000 lives or more (47% versus only 19% of employers with less than 2,000 lives; p<.05). Medical plan restrictions were also more common among the largest employers (40% in employers greater than 20,000 lives versus 19% among employers with less than 2,000 lives; p<.05).
Figure 11 shows the types of strategies employers are using to manage specialty drugs. The most frequently used strategies included managing inappropriate use (50%), ensuring proper dispensing source (43%), and management of days supply (42%).
Download Full Prescription Drug Benefit Cost and Plan Design Report or Request Print Copies