Specialty Pharmaceuticals

Specialty pharmaceuticals are medications that consist of complex molecules, are often complicated to deliver, and/or carry high costs.  Today, approximately a third of total pharmaceutical spending in the commercial market is devoted to specialty medications. If current trends in utilization hold, it is estimated that spending on specialty medications will comprise half of all pharmaceutical expenditures by 2018.

For many patients, specialty medications represent the most appropriate clinical recommendation.  However, the benefit delivered by any given medication may vary markedly depending on the particular circumstances around its use.  This variation is referred to as ‘clinical nuance.’

To constrain the rapid rate of increased spending, many payers have established high consumer cost-sharing requirements for these medications.  V-BID principles can be applied to align specialty medications and appropriate populations by basing consumer cost-sharing on a drug or treatment’s clinical value, not acquisition cost.

Access to prescription drugs is a hot-button health care issue.  The V-BID center proposes an innovative and dynamic benefit design – Precision Benefit Design– that recognizes that individualized therapies are often needed to achieve desired health outcomes.  This proposed benefit design plan lowers consumer cost-sharing for those who diligently follow the required steps for their condition, but require an alternative option.  View the comic below to see the impact of Precision Benefit Design in a doctor’s office of the future:

Implementing a V-BID prescription specialty medication plan that offers clinically nuanced cost-sharing based on patient- or disease-specific characteristics and that directs consumers toward high-value providers, payers, and purchasers can improve consumers’ access to necessary medications and reduce the likelihood of missed or delayed care and appropriate utilization of specialty medications.

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Specialty Pharma One-Pager Specialty Pharma White Paper Specialty Pharma Issue Brief

Additional Resources