Plan sponsors have many factors to weigh when evaluating how effectively a specialty partner can address the rising cost of medications while delivering quality care for members. Comparing quantitative figures like acquisition discounts, rebates per prescription and administration costs can seem like a relatively helpful and straightforward exercise. However, these findings should be combined with qualitative considerations spanning both cost and care management objectives to gain clarity into the holistic value a specialty partner can deliver.
The process of putting this into action can be challenging and complex. To help simplify it, there are two key areas plan sponsors can focus their efforts on.
1. Explore how effectively specialty trend management strategies can be integrated
When specialty trend management strategies like formularies, utilization management and value-based programs (among many others) aren’t deployed cohesively, plans miss out on significant synergies and savings.
Here are four questions to help see how well positioned a specialty partner is to capture these complementary savings opportunities instead:
- How efficiently can they manage specialty across both pharmacy and medical benefits? A comprehensive strategy across benefits can help plans improve visibility of their total specialty drug spend while mitigating clinical risks and administrative burdens.
- How robust and effective is their clinical model? A proven care model with evidence-based clinical protocols is integral to ensuring therapy appropriateness and lowering costs.
- Are they adequately prepared for new and emerging therapies? Sophisticated modeling tools and support systems can help inform coverage decisions around complex topics like gene and cell therapies or biosimilars.
- Do their trend management solutions come with a financial guarantee? While some specialty partners offer standalone financial guarantees tied to specific programs, a best-in-class partner will elevate that offer to a single, forward-looking financial guarantee—with assurance that it will be continuously optimized as new strategic solutions come to market.
2. Examine the level of clinical rigor applied across specialty pharmacy processes
Specialty conditions require high-touch, individualized care from seasoned, specialized clinical experts.
Here are four questions that can help uncover if a specialty partner’s clinical model is robust enough to deliver the level of care your members need:
- Are condition-specific experts available 24/7/365 and involved in local communities? To ensure patient safety and optimize outcomes, an always-on support model that includes education, counseling and local engagement is required.
- Does their care model emphasize whole-person health? Because specialty patients are at a disproportionately higher risk for comorbidities like depression, solutions to monitor drug-level therapy responses and patient-level risk factors are critical.
- How well have they developed and integrated digital tools across their care model? Once complementary to patient journeys, digital tools that drive engagement and support health progress are now core to the connected experience members have come to expect.
- Can they demonstrate clinical excellence through industry-standard credentials and proven results? A high-quality partner will be validated by specialty pharmacy-specific accreditations from the leading industry authorities, as well as a consistently strong track record of delivering superior results for clients.
While these tips merely scratch the surface of all the criteria to consider when assessing a specialty partner, they provide a solid foundation to build upon as you make important decisions about your specialty benefit.
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