Artemetrx Study Finds Higher Specialty Drug Pricing Under Pharmacy Than in the Physician Office for Commercial Plan Sponsors

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NASHVILLE, Tenn., March 19, 2014 (GLOBE NEWSWIRE) -- A report released today by Artemetrx Specialty Drug Solutions found higher unit pricing for specialty drugs dispensed through the pharmacy benefit than for the same medications administered in a physician office. Across all plan sponsors studied, the average price was 4% to 38% higher under the pharmacy benefit, depending on the drug.

The Artemetrx report analyzed 2012 pharmacy and medical claims data for specialty drugs for ten commercial plan sponsors of varying size and location. Drugs that are frequently paid under the pharmacy and medical benefit were examined in the study, including Epoetin (including both Epogen and Procrit), Neulasta, Remicade, Tysabri, and Xolair.

Key findings in the report include the following:

  • Across all plan sponsors studied, the price per unit was higher in the pharmacy benefit than the physician office for all five drugs examined.
  • Price differences varied widely by plan and drug, up to 31% higher for Neulasta for one plan's pharmacies compared with its physician offices.
  • Similar results were found when the analysis of pharmacy claims was limited to specialty pharmacies only.

"These findings counter historical thinking about the lowest-cost sites of care for specialty drugs," says Brenda Motheral, President of Artemetrx. "Specialty drug pricing differences between the pharmacy and medical benefits have been hard to understand due to differences in billing and payment models," noted Motheral.

In a 2013 survey of larger employers by the Pharmacy Benefit Management Institute, 30% of respondents were not sure which site of care has the lowest cost under their medical benefit. More than one-quarter of employers selected the "physician's office via a specialty pharmacy" as the lowest-cost channel. Only 10% said that "buy and bill" in the physician's office was the lowest-cost arrangement.1

"Our report underscores the need for plan sponsors to understand their own specialty pricing across different sites of care before deciding whether to move coverage of any specialty drugs from the medical to the pharmacy benefit," says Corey Belken, Vice President of Artemetrx. "There are other potential pros and cons to specialty drug coverage under the pharmacy benefit, making it important to evaluate both financial and nonfinancial considerations when choosing whether to move drugs out of the medical benefit into the pharmacy benefit," adds Belken.

To access the complete study, go to www.artemetrx.com.

About Artemetrx Specialty Drug Solutions

Artemetrx Specialty Drug Solutions provides analytics and cost management solutions that help plan sponsors manage their specialty drug spend across the pharmacy and medical benefit. Artemetrx clients include large employer, Taft-Hartley funds, hospital systems, third-party administrators, and health plans. Learn more at www.artemetrx.com.

1 Pharmacy Benefit Management Institute. 2014 Specialty Drug Benefit Report. January 2014. Available at www.pbmi.com.

CONTACT: Corey Belken Artemetrx, LLC. Telephone: 952-994-9459 cbelken@artemetrx.com Press contact: Kristin LaVitola 972-244-8388 klavitola@psgconsults.com

Source: Artemetrx