Specialty pharmacy costs are a growing concern for most healthcare payers. While specialty pharmacy often falls within PBM administration, it is estimated that nearly 50% of the total cost is embedded within medical spend. Current market conditions illustrate lower-than expected pharmacy trends, but it is specialty pharmacy that is largely driving total pharmacy costs and utilization increases. Currently averaging 50% of total pharmacy spend, specialty is expected to grow by double digits annually.

While the pure ingredient cost of specialty pharmacy is certainly a concern, the clinical programs surrounding specialty pharmacy are more relevant than ever. Excelsior Solutions helps clients develop a program that maximizes patient service levels while maintaining fiscal responsibility to the plan. The results of a successful program include lower baseline costs, increased member compliance, reduced admissions and overall improvement of the medical loss ratio.

Our team assists clients in developing:

• Specialty pharmacy strategy
• Formulary guidance
• Step therapy programs
• Vendor selection and contract negotiation
• Network evaluation
• Prior authorization criteria and process
• Overall clinical and trend management programs
• Specialty-only procurement

As a result, our clients are able to take a proactive approach to optimizing this complex and growing cost center.