Considerations for Specialty Drug Carve-Out Programs

This white paper prepared for AbbVie discusses considerations for plan sponsors evaluating specialty drug carve-out programs in response to rising specialty drug costs. It outlines how these programs involve contracting directly with vendors for specialty pharmacy benefits management, which may include services such as prescription drug fulfillment and prior authorization. The paper emphasizes that while vendors often advertise potential savings of 20% to 50%, plan sponsors must also consider other factors, including the interaction with existing pharmacy benefit manager (PBM) contracts, member experience, and overall financial implications. Key questions for plan sponsors are presented, focusing on PBM considerations, member experience, and financial impacts. The document further explains the distinctions between specialty drug carve-out programs and other funding strategies, highlighting the complexities involved in managing specialty drug costs while ensuring access to necessary treatments. The analysis aims to help plan sponsors make informed decisions regarding their employee benefits programs.