Curbing pharmacy-billed specialty trend with a comprehensive plan of action

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For patients with a complex health condition, their therapies can be life-saving. You may be facing an increase in the number of patients requiring specialty therapies in the future. Consider your members who delayed cancer screens over 2020 and 2021 due to the pandemic.

Over this time there was a:


reduction in mammograms1


decrease in colonoscopies1


drop in pap smears1

The market is already experiencing the rebound of screenings and health visits, which means an influx of specialty patients to come. You care about your members – that’s why you shouldn’t have to compromise care.

In addition to the clinical needs of your members,
there is the hard cost to your plan:

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5.4% average specialty trend in 2021 – that was 3% higher than traditional therapies.2

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Less than 2% of the population uses specialty drugs, yet those prescriptions account for a staggering 51% of total pharmacy spending.3

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It’s 75x more expensive to cover a single specialty patient’s drugs compared to just $492 for a non-specialty patient’s – a $38,000 average annual cost.2

If you haven’t taken aggressive action in the past, you need to take a look at all of your options now. Paving the way to an affordable specialty benefit starts with the ability for plans to implement proven and guaranteed specialty pharmacy controls without sacrificing member experience and outcomes.


Introducing: Specialty Advanced AssuranceSM

Specialty Advanced Assurance is a collection of proven solutions curated to optimize the pharmacy benefit and drive maximum value and affordability. To deliver better specialty drug predictability and affordability, we will be offering financial assurance that comes in the form of a guarantee.*

A coordinated package of capabilities – all working together – designed to deliver better value to you and improved outcomes to your members who need it most.

  • Utilization management, inclusive of biosimilar strategies
  • Value-based programs
  • Specialty formulary and pharmacy rebates
  • Copay solutions
  • Network and channel optimization
  • Patients and providers are guided to lowest net cost options.

    We apply our clinical expertise, size and scale to help you with tighter spend management, no matter the therapy class.

  • We ensure therapy is appropriate for the patient from the start.

    This includes reviewing nearly 500 specialty drug Prior Authorization clinical policies that have 1,000+ criteria updates made annually.

  • Trained clinicians support patients with the most complex conditions.

    Our 15 condition-specific Therapeutic Resource Centers® ensure superior clinical outcomes. For example, this drove a 96% cure rate for patients with Hepatitis C.4

  • Copay assistance strategies result in a $0 out of pocket cost to members.

    This amounts to hundreds of millions of dollars in net savings. Having copay support helps to drive better patient therapy adherence rates.

  • Your plan is reimbursed up to $2,000 per month.

    Our value-based care solutions in high-spend disease states, reimburse clients on an annual basis for things like early therapy discontinuation.