The Pharmacy Benefit Management Institute (PBMI) produced its eighth “Trends in Specialty Drug Benefits” which included 306 respondents involved with the drug benefit management within their organization. According to the PBMI, specialty drug consumption represents 50% of total drug spend. Employers face growing challenges as they seek to ensure their employees maintain access to medications. Rising specialty drug costs are coinciding with employers’ interest in value-based justifications of the same specialty drugs and their associated escalating costs. Structured reimbursement deals can provide employer-driven demands.
We see increasing numbers of outcomes-based contracts which enable patient outcome tracking; PBMI reported that 67% of respondents utilize these contractual instruments. 63% seek to track adherence and persistency while 27% track clinical efficacy. The tracking of medical impact on productivity represents less than 10% of respondents. The survey found that respondents are less interested in using formulary exclusions to manage the specialty trend. In the 2018 report, the number of respondents who think exclusions are effective declined 21%. However, this belief does not mean formulary exclusions are going anywhere. Sixty percent of respondents said they use formulary exclusions and 33% are considering adding or increasing their use. Follow the link to secure the report.