Key Takeaways from the 2024 PSG Specialty Drug Benefits Report
Specialty drugs continue to have an outsized impact on healthcare spending pushing plan sponsors into a new reality: navigating affordability, access, and accountability is more complex, and more urgent, than ever.
The 2024 Trends in Specialty Drug Benefits Report, released by the Pharmaceutical Strategies Group (PSG), offers a snapshot of how employers and health plans are adapting. Here are some of the key takeaways and what they could mean for the future.
Rebates Reign Supreme—But There’s a Catch
93% of plans report receiving pharmacy benefit rebates on specialty drugs. Another 44% receive rebates under the medical benefit—a growing figure, especially among employers. Rebates remain a dominant tool for cost containment, but they come with trade-offs: lack of transparency, delayed savings, and potential barriers to access. Notably, plans are warming up to non-rebate options, such as preferring lower-priced drugs without rebates or accepting smaller rebate guarantees in exchange for lower point-of-sale prices.
Alternative Funding Models: Still Controversial, Still Rare
Only 8% of plans use alternative funding programs that route members through third parties to access excluded medications. Even fewer believe these programs are sustainable. Concerns include member disruption, ethical and legal questions, and administrative burdens. While some plans have found value, others report mixed or negative experiences.
Utilization Management: A Necessary Pain Point?
Nearly all plans (97%) use prior authorization. Step therapy and quantity limits are also widespread. The most commonly reported unintended consequence is member dissatisfaction.
Only 25% of plans track “time to therapy,” even though delays may affect adherence and outcomes. Utilization strategies are under increasing scrutiny for their potential to unintentionally exacerbate health disparities, particularly among vulnerable populations.
Cell and Gene Therapies: The Coming Financial Shock
Gene therapies carry price tags as high as $3.5 million. Most plans expect affordability to become a major challenge in the next two to three years. Yet 41% of plans do not use any financial protection products for these treatments, and 38% say they don’t know enough about available options. Readiness is lagging behind innovation.
Biosimilars: Room for Growth
While 54% of plans use lowest-net-cost strategies, only 32% require patients to switch from branded biologics. Uptake of Humira biosimilars remains weak. Barriers include formulary strategies by PBMs, member hesitancy, minimal cost differentials, and limited educational support.
Top Goals & Frustrations
Plans most frequently rank these as their top goals:
- Manage total cost of care
- Control specialty drug trend
Their biggest challenge? Lack of reliable data on the total cost-of-care impact of medications. There’s a clear opportunity for better analytics, transparency, and integration.
Where RazorMetrics Fits In
The PSG report highlights the rising need for actionable data, smarter utilization management, and member affordability—without added complexity.
RazorMetrics addresses all three. We identify clinically equivalent, lower-cost alternatives using each member’s pharmacy claims and formulary. Then we communicate those options directly to prescribers. If and only if the doctor approves, we contact the member with the new, lower-cost prescription.
RazorMetrics’ physician-driven and member-friendly approach pledges:
- No added clicks in the EHR
- No switch unless the prescriber approves
- No change to the member’s pharmacy process
The result? Measurable savings for members and plan sponsors—with empathy, transparency, and clinical alignment.
Let’s Talk
If you’re looking for a smarter way to manage specialty drug costs, we’d love to show you what’s possible.
Contact us.
