2014 Specialty Drug Benefit Report
2014 Specialty Drug Benefit Report
Sponsored by Walgreens.

The survey was completed by a total of 337 U.S. respondents representing an estimated 14.3 million covered enrollees.

As in past years, the survey reflects PBMI’s ongoing process of monitoring market trends and adjusting the questionnaire to account for new developments. To address rapidly evolving policies for management of specialty medications within the medical benefit, the survey for the first time asked many key questions of the subgroup of employers with medical benefit coverage of specialty drugs. This modification will enable us to assess future changes in critically important areas of decision-making, such as cost-sharing and network management, specifically for the medical benefit.

Additional new question topics included respondents’ views of specialty versus retail pharmacies; their plans for the pharmacy network for specialty drugs; anticipated effects of biosimilars; time devoted to specialty medication management; and use of “stop-loss” coverage by self-insured employers. The survey also provides a more detailed look than it has in the past at several key topics, such as days supply limits and decisions about moving drugs from the medical to the pharmacy benefit. For this reason, some results may not be comparable to those obtained in previous years. The report denotes these items where applicable to enable the reader to interpret trends over time.