Rising healthcare costs continue to challenge employers, plan sponsors, and brokers — and specialty medication is a major driver of that pressure. While offering comprehensive pharmacy and medical coverage is essential to supporting your workforce, managing specialty drug costs across both benefits can quickly become complex, unpredictable, and difficult to control.
Specialty medications treat some of the most serious and chronic conditions, and although only a small percentage of members use them, they account for a disproportionate share of total specialty drug costs.
That reality makes affordability, transparency, and simplicity more important than ever — both for your organization and for the members who depend on specialty pharmacy services to manage their health.
So how can you help employees access the specialty care they need while keeping specialty drug costs manageable and sustainable? CarelonRx developed SpecialtyRx Savings Navigator to address this balance. Built around whole-health support and smarter specialty pharmacy management, it helps plan sponsors control specialty medication spend across medical and pharmacy benefits — with greater clarity, predictability, and cost efficiency.
Manage specialty drug costs today — plan and forecast tomorrow
To make a difference today, apply data-driven insights around optimizing care and savings. To improve the future outlook, use forward-focused tools for projections and customized modeling delivered through highly consultative reviews. SpecialtyRx Savings Navigator is a complete solution for active specialty medication management. It’s designed to empower employers who want to understand and address these expenditures across pharmacy and medical benefits, seamlessly, with enhanced capabilities, like:
- Advanced analytics. Prioritizes members with the highest-cost and highest-risk profiles for pharmacist-led outreach to improve whole health outcomes.
- Medical specialty drug and strategic channel management. Generates dynamic utilization and channel insights along with medical rebate savings to optimize medical specialty drug spend.
- Proactive utilization management. Enables clinically appropriate outcomes at the optimal site of care and point in time in the member’s prescribed specialty drug therapy.
- Disease-specific forecasting and custom plan recommendations. Helps employers to better plan for future specialty drug spend specific to their member population by leveraging our proprietary predictive modeling, delivered through highly consultative reviews.
Whole-health specialty support with proactive pharmacist-led guidance
People in need of specialized care often need the most guidance. That's why SpecialtyRx Savings Navigator goes beyond savings and budgeting tools, focusing first on plan members, and delivering the connected care they deserve. This includes:
- Pharmacist-led interventions. Proactively leads outreach to members to offer drug therapy optimization recommendations, address any barriers to care, and provide personalized referrals to available whole health resources.
- Connected care navigation. Seamlessly connects members to the appropriate resources, including medical and behavioral health professionals who can provide support for their specialty condition care journey.
- Affordability management. Offers management solutions for securing affordable and convenient care options for members, allowing them to focus solely on their health.
Simple, practical tools to manage specialty drug costs with confidence
For employers, the path to a more effective health plan doesn’t need to be complicated, costly, or unclear. SpecialtyRx Savings Navigator allows plan sponsors to manage their specialty drug spend more effectively than they might have thought possible. A rich bundle of tech-enabled features makes it easy to leverage this high-touch, high-impact solution for planning, budgeting, decision-making, and more:
- Advanced data analytics across both medical and pharmacy specialty drugs.
- Disease- and population-specific forecasting through proprietary predictive modeling.
- Benefit and product recommendations, personalized to improve member care and reduce spend.
With all its advanced capabilities, SpecialtyRx Savings Navigator equips employers with a powerful toolset for specialty drug management. It brings tangible options for improved affordability, promotes plan members' care and wellbeing, and allows you to focus on what truly matters – your employees' health, and your organization’s health, too.
To learn more about availability, reach out to your CarelonRx account manager today.
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