Managing Specialty Drug Costs with Confidence: An Integrated Approach That Can Save up to $87PMPM

Pharmacy benefits are one of the largest and most unpredictable costs in your health plan. They are also growing faster than employers expect.

Specialty drugs are a big part of that growth. These medications  treat complex or chronic conditions and often come with a high cost. While they make up a small number of prescriptions, they account for more than half of total pharmacy spend.

For employers, this can create real pressure. Even one or two high-cost claims can affect your overall budget and make planning more difficult.

As new therapies continue to enter the market, many employers are exploring different ways to manage these costs. Some options promise quick savings.

But it is important to look at how those savings are achieved and whether they can be sustained over time.  

What’s behind the rise in specialty drug costs

The specialty drug pipeline continues to expand, bringing new treatment options for a wide range of conditions.

Many of these therapies can improve outcomes for patients. At the same time, they often come with higher costs.

Today, employers are seeing:

• More employees using specialty medications
• Earlier use of these treatments
• Higher costs per prescription

Specialty drug spending is expected to continue growing, increasing both cost and uncertainty.

For employers, this means balancing access to care with the need for stable and predictable health plan costs.

Why separate specialty programs may create challenges

Some employers consider separate specialty pharmacy programs as a way to manage rising costs. These programs often focus on lowering expenses by handling specialty medications outside of the broader pharmacy benefit.

In some cases, they rely on manufacturer assistance programs to reduce costs. While this can seem helpful at first, there are important considerations.

These types of programs:

• May not apply to every medication or member
• Can change or end at any time
• May delay access to treatment
• Can make it harder to understand the full cost of care

They can also create a more disconnected experience for members and providers.

Over time, this can make costs less predictable and more difficult to manage. What looks like savings at the start may not continue in the long term.

A more connected approach to managing specialty costs

Many employers are moving toward a more integrated way to manage specialty medications. This approach keeps pharmacy and medical benefits working together, rather than treating specialty drugs separately.

With an integrated model:

• Costs are managed through established pricing and rebate strategies
• Care teams can look at the full picture of a member’s health
• You have full visibility into both medical and pharmacy spend
• Savings are more consistent and easier to track

This approach can also help reduce unexpected cost spikes and support better care for your employees. When benefits are aligned, members are more likely to stay on treatment and avoid disruptions, and employers benefit from more stable costs and better long-term outcomes.

What this means for your organization

Specialty drug costs will continue to grow as new therapies become available. The approach you take today can shape how well your health plan performs in the future.

This includes:

• How predictable your costs are
• How easy it is to plan and budget
• How well your employees can access the care they need

Some approaches may offer short-term savings but add complexity over time. Others focus on building long-term value into your plan.

Looking ahead

Managing specialty drug costs is not just about reducing expenses. It is about finding the right balance between cost, access and quality. As the specialty drug landscape continues to evolve, having a clear and connected strategy can help you stay ahead of change instead of reacting to it.

An integrated approach can provide more stability, better visibility, and savings you can plan for over time.

If you are reviewing your pharmacy strategy, this is a good time to take a closer look at how your approach supports both your employees and your organization.

Disclaimers:

1. What Are the Projected 2025 Health Plan Cost Trends? Segal. September 18, 2024. Accessed April 8, 2026. https://www.segalco.com/consulting-insights/2025-health-plan-cost-trend-survey