Managing Specialty Drug Costs: Why a Proactive Strategy is Key to Sustainability

Specialty drugs are one of the fastest-growing drivers of pharmacy spend. Although they often serve only a small percentage of plan members, the outsized cost of specialty drugs can quickly strain employer budgets and impact member affordability. Leaving specialty drug spend unmanaged isn’t a tolerable risk – it’s a threat to sustainability.

Thankfully, employers don’t have to choose between controlling costs and offering quality care. With proactive management and integrated plan strategies, it’s possible to meaningfully reduce specialty drug spend while improving the member experience.

How Specialty Drugs Drive Costs Upwards

Specialty medications often account for a disproportionate share of total pharmacy costs. Individual therapies can often cost tens of thousands of dollars per year. These may include treatments for autoimmune conditions, cancer, rare diseases, and other complex chronic conditions.

If specialty drug spend isn’t proactively managed, employers may face:

• Rapid and unpredictable budget increases
• Higher out-of-pocket costs for members
• Disruption in member care

Left unchecked, specialty pharmaceutical spend quickly becomes one of the largest threats to long-term plan sustainability.

Why Traditional Pharmacy Approaches Fall Short

Many self-funded employers rely on traditional pharmacy benefit manager (PBM) models that don’t adequately address the realities of specialty medication use. These models are often limited by:

• Limited transparency, with pricing that obscures true costs
• Rebate-driven incentives that prioritize brand-name medications over the lowest-cost options
• Minimal or no use of available savings opportunities
• Limited adoption of biosimilar medications, even when clinically appropriate and significantly less expensive
  

These gaps leave employers reacting to rising costs rather than proactively controlling them.

Proven Strategies that Control Specialty Drug Spend

Thankfully, there is a better way to manage specialty pharmaceutical costs. By shifting toward integrated pharmacy strategies, employers can address cost, access, and member support simultaneously. Some key approaches include:

• Formulary management to steer to clinically equivalent, lowercost options
• Personal importation for eligible medications, members can access brand-name drugs at 50-60% lower cost.
• Clinical review for medical necessity with ongoing clinical oversight helps identify safe, effective, and lower-cost alternatives whenever possible.
• Biosimilars – leveraging lower-cost equivalent medications can deliver substantial savings while maintaining the same clinical outcomes.

Individually, these strategies help. But when they work together, like through VeracityRx, they create a powerful framework for controlling specialty drug volatility.

How Technology Supports Member Engagement

Cost control measures are impactful, but engaging plan members also matters. Technology and proactive engagement play a critical role in successful specialty drug management.

With tools like the VeracityRx app, members receive:

• Real-time visibility into medication costs
• Alerts for assistance opportunities for high-cost medications
• Simple and easy prescription transfers

Paired with proactive outreach and education, these tools help members stay adherent, informed, and supported, whether they’re on specialty drug medications or not.

The Real Savings for VeracityRx Members

Adopting VeracityRx’s integrated specialty drug strategies has delivered real, measurable results for our partners:

• One employer saw $180,000 in annual savings after a member qualified for a manufacturer assistance program
• Another employer received $76,000 in annual savings through biosimilar adoption
• VeracityRx strives to provide minimal to no disruption in therapy, while plan members still benefit with little to no cost.

These outcomes show that cost reduction and positive member experiences can coexist through VeracityRx’s integrated model.

The Bottom Line

For self-funded employers, managing specialty drug cost is not optional – it’s essential. As specialty medications continue to drive pharmacy spend upward, employers need solutions that go beyond traditional PBM models. With VeracityRx’s integrated approach, employers can achieve significant savings without sacrificing care.

Learn more about VeracityRx’s integrated pharmacy solutions that value transparency, reduce financial risk, and prioritize member support.