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Managing the Cost of Specialty

Specialty: this buzz word is stirring up the health care industry. With everyone talking about these high dollar medications, we wanted to provide some education about how you can manage specialty costs.

What are Specialty Drug Products? Specialty drug products are used to treat complex chronic conditions such as rheumatoid arthritis, HIV, Hepatitis C and multiple sclerosis.

The Good News… These ground breaking therapies continue to make great advances for improved patient quality of life, better management of disease states, and in some cases, curing the disease altogether. And for employers, this means increased health care savings (due to lower medical claims) and improved productivity (due to better disease management).

The Bad News… The expense associated with these diseases and therapies is significant, and causing sticker shock. The use of specialty drugs for employer groups is expected to quadruple by 2020. This leads us to the very popular questions surrounding specialty: How do we begin to swallow these large numbers associated with chronic care? What solutions are available to help with managing specialty costs?

Effectively Managing Specialty Costs: Protecting your company’s investment in its chronic plan population begins with ensuring appropriate use of these high dollar medications.

Two Key Components for Effective Specialty Management = 

#1  Prior Authorization: It is important to have strong clinical prior authorizations in place from your PBM to ensure that the right individual is getting the right drug.

#2   Patient Education & Chronic Care Guidance: Provide your plan members with the necessary tools to reach the goals they need to achieve with those medications. Pharmacists are an excellent resource to assist with working with patients who are taking specialty medications.  Tria Health pharmacists are credentialed and trained to help with these types of situations.


Jessica Lea, Pharm.D., MBA

If you feel unprepared for the rising (and expensive) trend of specialty medications, let Tria Health help you implement a solution to reduce the cost and improve the efficacy of these expensive medications.

Written by: Jessica Lea, Pharm.D., MBA President & CEO, Tria Health


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