Replay - Cracking the Code: Unraveling Specialty Drug Costs & PBM Profits

For most plan sponsors, specialty drug costs continue to climb, sometimes reaching 50% of total pharmacy spend! Capital Rx's Josh Golden, Senior Vice President of Strategy, hosted an informational webinar on September 14, 2023, covering specialty drugs and how they have become a significant source of profit for legacy pharmacy benefit managers (PBMs). Josh explained the reasons behind the surge in specialty drug costs and how the PBM profit structure may be part of the problem, the eight ways a PBM can make money from a single specialty drug claim, and why biosimilars warrant heightened attention. Most importantly, he reviewed what levers plan sponsors may be able to pull to manage specialty drug spend and what language to look for or include in a PBM contract related to specialty drugs.

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Check out the replay and highlights below, and CLICK HERE for the presentation materials!

Highlights

• The 3 Sources of Specialty Profit Growth for PBMs [05:45]

• Why Defining Specialty Drugs is Hard, and the Problem for Plan Sponsors [13:19]

• How a PBM Profits from a Specialty Drug Claim [20:31]

• Drug Mix and the Importance of Utilization Management (PA) [25:00]

• Biosimilars Overview and What Plan Sponsors Need to Know About Biosimilars to Humira [33:24]

• Strategies Plan Sponsors Can Deploy NOW to Control Specialty Costs [43:57]

• Alignment is Fundamental to Driving Down Specialty Costs + Procurement Recommendations [54:18]

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To learn more about Capital Rx's aligned PBM model, CLICK HERE to get in touch!

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