What to measure
Evidence before assumptions.
- Net pharmacy cost
- Pricing model transparency
- Specialty-drug trend
- Contract guarantee performance
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Component 04
Pharmacy & Specialty Drug Management
Do we understand the economics behind every pharmacy dollar?
Clear definition
Pharmacy and specialty drug management gives employers visibility into PBM pricing, rebates, specialty sourcing and clinical programs so pharmacy is managed as a strategic spend category.
Common mistakes
What weakens performance.
- Leaving pharmacy economics inside a bundled arrangement
- Treating rebates as the full measure of value
- Skipping PBM audit rights
High-performance practices
Build a deliberate approach.
01
Review pass-through and spread-pricing alternatives
02
Audit contract guarantees and rebate treatment
03
Develop strategies for biosimilars, GLP-1s and specialty sourcing
Book connection
Chapters 6–7: Pharmacy economics
Chapters 6, 7 and 20
The pharmacy chapters unpack the arrangements, guarantees and sourcing decisions that determine net drug cost.
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Pharmacy & Specialty Drug Management
Does the employer have visibility into PBM pricing, rebates, specialty spend and contractual guarantees?
A lower score makes PBM transparency and specialty-drug strategy a near-term diagnostic priority.
Take the Health Plan ScoreEmployer Benefits IQ resource
PBM Comparison Tool
A printable Employer Benefits IQ worksheet for defining the decision, evidence, accountable owner and review cadence.
Author perspective
By Corry Hull, REBC, CSFS — Author, The High Performance Health Plan and Founder, Employer Benefits IQ.
Explore the Health Plan Score