PLANO, TX--(Marketwired - Mar 4, 2016) - The Pharmacy Benefit Management Institute (PBMI) released the results of its fifth annual Trends in Specialty Drug Benefits Report at its 21st Annual Drug Benefit Conference in Palm Springs, California. Results show that employers are concerned about the rising costs of specialty drugs, but continue to strive to provide valued drug benefits for employees. The report includes responses from 341 employers covering an estimated 14.5 million lives. 

"With the pipeline full of specialty medications, it's no surprise that employers continue to spend more time on specialty drug management," says Jane Lutz, Executive Director of PBMI. "While many employers report having or evaluating separate cost-sharing tiers and formulary exclusions as part of their benefit design strategy, several opportunities still exist on the medical benefit."

Key findings from this report include:

  • Specialty drug cost trend and reducing inappropriate utilization remain the top two benefit design goals.
  • Fifty-four percent of smaller employers cover specialty drugs under the pharmacy benefit, while larger employers cover these drugs under both medical and pharmacy benefits.
  • Nearly one-third of respondents are planning to implement a separate cost-sharing tier for specialty drugs.
  • Larger employers purchase stop loss insurance much less often (63%) than smaller employers (95%).
  • Average coinsurance increased from 29% to 33% for percentage cost-sharing designs under the pharmacy benefit.
  • Employers are uncertain about the effectiveness of formulary exclusions for managing specialty trend and note member dissatisfaction and clinical disruption as key challenges.
  • Specialty formulary exclusions are most common for growth hormones, cholesterol, fertility, hepatitis C, and multiple sclerosis.
  • Value-based pricing models are catching the attention of employers with 82% expressing interest.
  • Opportunities exist for increasing the use of specialty management programs in the medical benefit:
    • Twenty-nine percent of employers do not have a prior authorization program in place.
    • Forty-one percent do not have clinical care management programs.
    • Less than half (46%) have step therapy in place.

PBMI will host a free webinar on March 8, 2016 at 1:30 pm EST to discuss the results of this report. Register today. Click here to order.

About PBMI
The Pharmacy Benefit Management Institute provides research and education to help health care and benefits professionals work with pharmacy benefit managers to design prescription drug benefit programs. Learn more at

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Julie Blackman