Service
Specialty Pharmacy
Specialty drug strategy, channel design, and biosimilar transition planning
Specialty drugs are now more than 50% of total pharmacy spend for most plans, despite being less than 2% of prescription volume. TeliosRx specialty pharmacy services cover the strategic decisions that drive specialty cost: channel mix between pharmacy benefit and medical benefit, prior authorization criteria, copay assistance program coordination, biosimilar substitution strategy, and 340B program review for eligible covered entities.
What's Included
- Specialty spend analysis by drug, channel, and member
- Channel optimization (pharmacy benefit vs medical benefit)
- Biosimilar substitution strategy and timeline
- Prior authorization and step therapy criteria review
- Manufacturer copay assistance program optimization
- Site-of-care recommendations for infused drugs
- 340B program integrity review for eligible entities
Our Process
- Baseline specialty spend audit
- Identify top channel-shift and biosimilar opportunities
- Develop transition plan with clinical and patient considerations
- Coordinate with PBM and specialty pharmacy on implementation
- Track savings impact and refresh strategy quarterly
Who This Is For
Plans where specialty spend is 40%+ of total pharmacy spend, or growing at 15%+ annually. Especially valuable for plans with significant biosimilar opportunity (Humira, Stelara, Avastin, Remicade).