Managing the Specialty Medication Challenge: Benecard's Comprehensive Approach

The rapidly escalating costs of specialty medications present one of healthcare’s most pressing challenges. With specialty drugs now accounting for over 75% of drug development1, plan sponsors and patients alike face mounting financial pressure.  

These medications, while often life-changing for patients with complex conditions, are a key driver of rising pharmacy trends. To help manage these critical medications effectively, Benecard has developed a comprehensive Specialty Management Program that combines clinical expertise with cost containment strategies.

Our Approach Is Yielding Results 

Benecard’s specialty spend currently averages around 47% of total drug spend and our specialty claims account for about 2% of total claims2. These figures are notably lower than industry averages, where studies show specialty spend typically accounts for approximately 54% of total drug spend3, and specialty claims can comprise up to 5% of total claims4. This demonstrates that with the right strategies in place, it’s possible to manage the impact of specialty prescriptions more effectively while still ensuring access to these vital medications. 

Personalized Clinical Services 

Benecard’s clinical services maximize opportunities to collaborate with members, their prescribers, and dispensing pharmacies. From diagnosis to treatment, our on-staff pharmacists and nurses evaluate cost savings, member safety issues, and best health outcomes through a series of comprehensive reviews. This personalized approach ensures that specialty medications are being prescribed and used appropriately while maximizing therapeutic outcomes. 

We offer our members a comprehensive clinical package that includes the following: 

• Drug Quantity Management 
• Patient Education Mailings 
• Clinical Reviews 
• Drug Utilization Reviews 
• Step Therapy 
• Clinical Cost Management 
• Drug Pipeline Monitoring 
• Drug Optimization Program 
• Fraud, Waste, and Abuse Identification 

Looking Ahead 

As specialty drug costs continue to rise, Benecard remains committed to innovating our management strategies. We are constantly evaluating emerging trends in the specialty medication landscape and developing new approaches to address these challenges.  We understand that specialty medications can be life-changing treatments that help patients manage complex conditions and improve their quality of life.  That is why Benecard has always been dedicated to helping our members receive the care they need at an affordable cost while simultaneously helping our clients control their overall pharmacy benefit expenses. 

Read more about Benecard’s Clinical Guarantee: https://www.benecard.com/clinical-guarantee/ 

Sources:  
1: https://www.pharmacytimes.com/view/navigating-the-rapid-growth-of-specialty-drugs-opportunities-challenges-and-the-path-ahead  
2: Data based on Benecard’s book of business for 2024 (YTD) 
3: “The Use of Medicines in the U.S. 2024”, IQVIA Institute “
4: “2024 Trends in Specialty Drug Benefits Report”, PSG Consults