Inflated savings, hidden costs: How vendors who “carve-out” specialty benefits fail to deliver promised value

MedCity News June 13, 2021
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In recent years, a number of niche vendors have entered the market, promising significant savings for payers if they “carve-out” specialty pharmacy services from integrated pharmacy benefits management (PBM). While the savings they claim to provide sound undeniably attractive, they are often greatly exaggerated.

Specialty medications – high-cost medications that treat complex, chronic conditions – have become a key driver of overall prescription drug spend. In fact, according to CVS Health’s 2020 Drug Trend Report, they account for 52% of spend despite being utilized by only 2.5% of all patients. Spending on these medications is growing rapidly as more specialty treatments continue to be launched at high prices and medications already in the market obtain supplemental indications to treat additional...

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