The evolution of specialty drug risk transfer gains speed as more employer sponsored health plans face crippling and unsustainable costs for drugs that shouldn’t cost that much………………and don’t in other countries.
The risk transfer, full circle process:
- Mfg. marks up the price of a patented specialty drug to include commissions (rebates)
- PBM places the specialty drug on their covered drug listing
- Plan sponsors transfer the risk to stop loss policy
- Stop loss policy transfers the risk back to the plan sponsor in the form of lasers
- Plan sponsor excludes specialty drugs from list of covered drugs – transfers the risk back to mfg. patient assistance programs
