Meet Your New Medical Specialty Savings Solution

Do They Have the Skills to Pay Your Bills? 

If you asked a football coach to teach a bunch of kids how to play well as a team, you’d get what you asked for. However, if you asked him to do your taxes, you’d probably be unhappy with the results. Why? Because it’s not what he was trained for. 

The same thing is happening every single day when specialty drugs are administered under the medical benefit instead of the pharmacy benefit. Meaning plan sponsors are leaving key decisions up to a medical benefit that was never equipped to handle these high-cost medications. And with nearly 40% of specialty drug costs falling under the medical benefit, the potential financial risks are staggering. 

Here are just some of the medical benefit challenges that increase financial risk: 

• Limited visibility into drug spend 
• Highly variable pricing across care settings 
• Applying drug-specific clinical oversight 
• The risk of being overcharged and overbilled 

The following graph illustrates how widely the cost variance can range on an average specialty medication, in some cases by as much as $20,000. And that’s for just one medication.

The Continuing Health Care Costs Crisis 

It’s no secret that health care costs are on the rise. Overall health spending is almost $4.9 trillion and projected to increase nearly 6% per year over the next decade.¹ But if you only look at specialty medication, the rate more than doubles to an estimated 13% annual increase for the next three years. Not to mention that the median cost of a new specialty drug in 2023 was $300,000 annually.² 

So, if you combine the extremely high specialty costs, lack of transparency and the shortcomings around costs funneling through the medical benefit, it’s easy to understand how relying on the wrong system can be a recipe for financial disaster. 

That’s why plan sponsors need a medical specialty management solution that’s backed by specialty drug experts. 

How Our Medical Specialty Drug Management Works 

Through our partnership with Archimedes, Navitus offers best-in-class comprehensive solutions that manage the full spectrum of specialty drug costs, giving more clarity, control and value. Our medical specialty drug management solution 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 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 

Navitus Medical Specialty Management Results 

• Average savings of ~$35-50K per case
• Manage 100% of your specialty drug costs
• Guaranteed 2:1 ROI for groups over 2,500 lives

Real-life Impact and Savings 

When Navitus is managing your medical specialty, we look at every aspect of how drugs are administered and paid for, not just the bottom line. 

While reviewing their files, we noticed a member was receiving infusions at an outpatient facility costing $77,343 per infusion. We contacted the provider to recommend a switch to home infusion, to which they and the member agreed. As a result, the member gets to enjoy the convenience of at-home infusions for less than half the original cost: $33,743 per infusion. That’s an annual savings of over $87,000. 

In another instance, it was identified that a member was utilizing a biologic drug under the medical benefit that had several lower cost biosimilars available. Through provider outreach and education, a switch was made to a lower cost biosimilar, unlocking annual savings of $60,000.

Now is the Time to Make the Switch 

Medical costs are continuing to rise at an extraordinary rate. Specialty medications are being mismanaged under the medical benefit, which lacks transparency, oversight and the experience needed to make a difference. Plan sponsors that value their members and the ability to offer affordable coverage can’t afford to wait any longer. 

It’s time for plan sponsors to step in and take the reins of medical specialty management, and Navitus is here to help you do just that. 

Take control of your full pharmacy spending. Contact us to learn about our medical specialty management solutions. 

References

1 American Medical Association, Trends in Healthcare Spending. www.ama-assn.org/about/research/trends-health-care-spending#:~:text=Health%20 spending%20in%20the%20U.S.,%25)%20and%202021%20(18.3%25). Updated April 17, 2025. Accessed April 23, 2025. 

2 Krishnamurthy B, Parikh M, Drug Prices and Shortages Jeopardize Patient Access to Quality Hospital Care. Drug Prices and Shortages Jeopardize Patient Access to Quality Hospital Care | AHA News. Updated May 22, 2024. Accessed October 8, 2025.