Assessment of Specialty Generics Contract with PBM

IndustryHealth System
ProblemA health system made a change in their PBM contract to separate specialty products into brand and generics. The client reached out to PHSL to ensure this was a financially beneficial decision and to aid in planning for future negotiations.
PHSI SolutionPHSL reviewed specialty generic rates using prescription claims data, reimbursement rates, and acquisition cost trends to provide insights on the resulting change for the health plan.
ResultsPHSL’s data analysis indicated specialty generics follow a trend similar to non-specialty generics. This validated that a separate contract rate for specialty generics was a favorable decision the client, based on their specific book of business, and gave them the guidance to shape future decisions.