BERWYN, Pa.--(BUSINESS WIRE)--AscellaHealth, a national specialty pharmacy benefit manager (SPBMTM) serving commercial, Medicare and Medicaid segments, forecasts the overriding trend in 2021 among employers, third party administrators and payers will be the adoption of a specialty pharmacy Rx and/or medical benefit carve-out program that designates one vendor management model across the medical and/or pharmacy benefit channel. As a departure from the traditional pharmacy benefit management approach, a coordinated specialty medical Rx strategy that addresses the complexities of high-cost specialty claims enables a holistic view of member behavior that prevents unsafe or overly complex prescribing, which is crucial to lowering the total cost of care.
“With the average cost of a specialty medication 10 to 15 times greater than that of traditional branded drugs, it’s no surprise that employers identify managing specialty drugs as the highest priority,” says Dea Belazi, president and CEO, AscellaHealth. “By 2022, 47% of the pharmacy industry’s expenditures will come from specialty drug, making medical integration an important strategy for managing specialty costs. Partnering with AscellaHealth can result in incremental specialty medication savings on the pharmacy and medical plan.”
AscellaHealth offers real-time analysis across medical, pharmacy, clinical and therapeutic data to help employees receive optimal care and experience better outcomes. This includes:
- Rapid identification of at-risk employees for timely and targeted outreach and intervention
- Comprehensive care coordination for chronic conditions – like hemophilia, intravenous immunoglobulin, multiple sclerosis and hereditary angioedema
By carving out medical pharmacy benefits, plan sponsors create the potential to save up to 20+% per year on benefits costs, with fewer emergency room visits and hospitalizations. Medical integration also helps reduce therapy medication optimization by curbing waste and inappropriate prescriptions, including incorrect dosage. An estimated $250,000 in savings could be achieved in one year with a single disease category carve-out.
Other AscellaHealth benefits include transparency around the total cost; lower pharmacy costs; ability to engage in highly aggressive price negotiations; better contract terms; improved data management for accurate forecasting, modeling and planning; and custom clinical programs, such as hemophilia management, oncology programs and multiple sclerosis treatments.
A pharmacy carve-out plan offers significant advantages to both employers and employees. It allows for greater access to useful medical pharmacy claims data, and more control over costs. This means employers will no longer be in the dark about specific drug mark ups or other factors that could increase the cost of pharmacy benefits. Employers gain better drug prices within their plan sponsors, instead of accepting what a carve-in plan offers. This includes negotiations on expensive specialty drugs that are growing in both cost and utilization. A specialty carve-out plan and additional clinical programs can help reduce costs for an employer group, and improve the life of contract terms that put the decision making power in the hands the employer.
“By carving out specialty pharmacy, stakeholders can mitigate risk, optimize plan performance and generate savings for the plan and its participants,” Belazi concludes.
AscellaHealth, a national specialty pharmacy benefit manager (SPBMTM), serving commercial, Medicare and Medicaid segments, offers high quality prescription drug benefit management services. Complemented by other customizable services, such as carved-out specialty pharmacy services and cost-savings programs, AscellaHealth provides a unique, proprietary service portfolio. Visit www.ascellahealth.com.