Seize the Opportunity to Control Your Specialty Drug Spend

Provider-administered specialty drugs covered under the medical benefit can cost far more than their average wholesale price (AWP). As a result employers that fail to manage their medical specialty drug spend risk overspending.

If your organization covers specialty drugs under the medical benefit, consider these questions:

Do you know how much you are spending on specialty drugs under your medical benefit?

Do you know if your members are receiving their infusions at the most convenient and cost-effective sites of care?

Do you know the approval rate of prior authorizations for specialty drugs under your medical benefit?

Do you know if you are receiving manufacturer discounts for specialty drug utilization under your medical benefit?

If you answered “no” to any of these questions, then our Medically Administered Pharmacy (MAP) Formulary is tailored for you. Navitus’ innovative MAP Formulary is created exclusively for physician-administered specialty drugs, helping employers manage this hidden side of specialty drug spend.

With nearly 40% of specialty drug spend occurring under the medical benefit, it is imperative for employers to manage this part of their drug spend in order to control their specialty drug costs.1 Specialty drug prices can vary wildly under the medical benefit, being subject to provider charges that are as much as 10 times the AWP. Even in the case of more modest hospital or physician charges, employer costs under the medical benefit are often still double to triple that of Medicare reimbursement rates.2

Our MAP Formulary helps employers minimize their risk of overspending by managing their medical specialty spend under our lowest-net-cost pharmacy benefit. When you add our turnkey MAP Formulary to your Navitus pharmacy benefit, you unlock the following tools to manage your medical specialty drugs:

Cost Transformation

Substitute the uncertainty and high variability of buy-and-bill reimbursement with a specialty pharmacy network featuring pass-through discounts based on drug list prices, not provider charges.

Value: Cost transformation savings can approach $10 PMPM.

Site of Care

Gain access to more convenient and cost-effective alternative options for your members to receive their specialty drug infusions.

Value: Single member site-of-care transitions can save over $1 million annually.

Medical Prior Authorization

Apply Navitus’ lowest-net-cost approach to your medical specialty drugs while ensuring clinically appropriate utilization.

Value: Navitus’ prior authorization approval rate for medical drugs in 2020 was under 70%.

Preferred Products

Earn additional discounts when you utilize certain preferred, lowest-net-cost medical specialty products.

Value: Biosimilars can cost 10-57% less compared to their originators.

The time to take control of all your specialty drug spend has arrived. Contact your Navitus account representative or email [email protected] to get started.

State of Specialty: Spend and Trend Report. Pharmaceutical Strategies Group. https://www.psgconsults.com/specialtyreport. Published October 2020. Accessed March 8, 2021

Navitus internal data.

Stay Informed and Connected

Receive expert insights, healthcare tips, and important updates on pharmacy benefits, drug recalls, and more—straight to your inbox.

Examining Trends that Drive Informed Decisions

Now Available: 8th Annual Drug Trend Report

See the latest results and access industry insights you need to navigate current trend drivers.

Related blogs

Navigating Healthcare and Improving Outcomes

Achieving Outstanding Results with Tailored Network Strategies

Achieving Outstanding Results with Tailored Network Strategies

A medium-sized city in Michigan with 1,350 members was seeking ways to lower its pharmacy benefit costs, which were growing under its existing traditional pharmacy benefit manager (PBM). With its member covered by a two-tier, open formulary including…

Breaking Through Barriers with Value-Based Plan Design

Breaking Through Barriers with Value-Based Plan Design

Facing increased pharmacy benefit expenses, Blain’s Farm and Fleet, a Midwestern employer group, desired to improve plan performance. Specifically it was interested in educating eligible members about the benefits available to them, promoting cost-effective…

Finding a Solution to Lower Prescription Drug Costs

Finding a Solution to Lower Prescription Drug Costs

The Rural Arizona Group Health Trust (RAGHT) wanted to gain better control of its escalating drug trend with its large, traditional pharmacy benefit manager (PBM). Having only worked with traditional PBMs in the past, RAGHT was interested in exploring…

Empowered by Strategic Opportunities and Service Excellence

Empowered by Strategic Opportunities and Service Excellence

Putnam | Northern Westchester Health Benefits Consortium (PNW HBC) was the first municipal cooperative health plan in the state of New York to become certified by the Department of Insurance. They are dedicated to meeting — and exceeding — the standards…

QUALYiQ Program Delivers Significant Savings for Both Members and Health Plans

QUALYiQ Program Delivers Significant Savings for Both Members and Health Plans

As part of their treatment plan for hypophosphatasia (HPP), a rare genetic disorder affecting bone and teeth development, one of our members required Strensiq, a medication designed to manage HPP. However, Strensiq’s annual treatment costs ranged from…

RISE: Reporting and Intervention for Stars Excellence

RISE: Reporting and Intervention for Stars Excellence

RISE is a comprehensive Star Ratings Improvement program that focuses on positive outcomes for Medicare Part D (Part D) clinical measures, including: medication adherence for diabetes medications, medication adherence for hypertension, medication adherence…

Medication Therapy Management: Improving Health Outcomes and Reducing Cost

Medication Therapy Management: Improving Health Outcomes and Reducing Cost

Patients with chronic diseases can face greater risks for medication-related challenges such as non-adherence. This can lead to poor health outcomes and higher plan costs. That’s why we developed an MTM program, offered through our Clinical Engagement…

Personalized Member Transitions: Creating a Smoother Benefit Transition

Personalized Member Transitions: Creating a Smoother Benefit Transition

Navigating benefit transitions is no easy task. Our personalized member transition (PMT) program makes it smoother for both plan sponsors and members. Through our high-touch outreach to members, we eliminate gaps in care, minimize member disruption, improve…

Pharmacy and Practitioner Exclusions and How to Resolve Them

Pharmacy and Practitioner Exclusions and How to Resolve Them

Prescribers and Pharmacies can be deemed ineligible for providing services to government programs like Medicare, Medicaid or even to payers who are participating in government programs. Being ineligible to provide those services is commonly referred to…

previous arrow
next arrow