High-Cost Specialty Drugs
Medical Specialty Drug Management
Our program helps plan sponsors and health plans control specialty drug costs across pharmacy and medical benefits by applying our proven lowest-net-cost management tools.
Medical Specialty Management Overview
Managing High-cost Specialty Medications More Effectively
Are you confident that you’re effectively managing 100% of your specialty drug spend? While Navitus already helps you manage the portion of specialty drug costs under the pharmacy benefit, nearly 40% of these costs fall under the medical benefit, which was never designed to effectively manage them. And with a $300,000 annual median cost for new specialty therapies, that’s a lot of financial risk.
Medical benefit challenges that increase the financial risk:
- Limited visibility into drug spend
- Highly variable pricing across care settings
- Applying drug-specific clinical oversight
All of these complications mean that you need someone with deep drug management expertise to assist you.
Through our partnership with Archimedes, Navitus offers best-in-class comprehensive solutions that manage the full spectrum of specialty drug costs, bringing clarity, control and value.
Have Questions?
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Managing High-Cost Specialty Medications More Effectively
Up to $1 million in specialty drug spend can be hidden within the medical benefit—representing 35% of total costs that lack transparency. Many of today’s highest-cost therapies, like gene treatments, are billed under the medical benefit. This creates challenges for plan sponsors and health plans, including:
To manage the full picture of specialty drug costs, plans need solutions that span both pharmacy and medical benefits. Through our partnership with Archimedes, Navitus offers a comprehensive approach to specialty drug management—bringing clarity, control, and value.
High-Touch Approach
How It Works
Our medical specialty management applies trusted pharmacy-level oversight to medical specialty drugs, helping plans save money while ensuring the right care.
We accomplish this through our comprehensive programs and strategies, including:
- MAP (Medically Administered Products) Formulary – Enables for lowest-net-cost pharmacy benefit coverage where pricing is more transparent and manageable
- Enhanced Clinical Management – Combines evidence-based care with robust utilization management strategies, such as prior authorization, quantity limits and site-of-care optimization
- Specialty Pharmacy Dispensing & Billing – Treats medical specialty drugs like pharmacy benefit drugs, ensuring they’re adjudicated quickly, dispensed efficiently and monitored seamlessly
- RxPostCheck™ – Powered by Archimedes, it couples retrospective in-depth claims analysis with clinician-based interventions to enact cost-saving changes
This program’s full complement of offerings delivers a 2:1 ROI (subject to minimum group requirements). Contact us to learn about our additional medical specialty management solutions.