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How SBS Can Help

We understand the significant pressure on plan sponsors to continue to offer complete specialty benefits for your members while managing plan costs. With rising drug cost, new drugs coming to market, and increased utilization in many classes, we know this can be a daunting task.

That is why Express Scripts offers Specialty Benefits Services, the most comprehensive range of specialty benefit and drug management services in the market. Our goal is to enhance patient care and solve your specialty cost challenges through Specialty Medical Benefit Management, Specialty Pharmacy Benefit Management and Specialty Pharmacy and Distribution.

Specialty Medical Benefit Management

Care Continuum, an Express Scripts company, provides the most comprehensive range of trend and utilization management tools for drugs billed through the medical benefit. We provide:

Utilization Management – Ensuring the safe and appropriate use of high-cost specialty drugs 

Site of Care Management – Redirecting patients and medications to the lowest-cost and most appropriate channel 

Reimbursement Management – Verifying claims are paid at the contracted rate and improving opportunities to achieve rebates

Oncology Decision Support – Driving cost-effectiveness and quality care through evidence-based treatment plans

The medical benefit typically lacks the oversight traditionally found in the pharmacy benefit. With almost half of specialty drug spend occurring in the medical benefit, the toll is high. Plan sponsors will waste over $9 billion in 2015 alone due to inadequate management of specialty medication in the medical benefit. Medical Benefit Management bridges the gap and offers guaranteed savings.

Specialty Pharmacy Benefit Management

For more than 25 years, Express Scripts has been a leader in trend and utilization management for drugs billed through the pharmacy benefit. We now use our expertise to apply the same proven tools to specialty drugs billed through the pharmacy benefit. Our innovative specialty programs include:

Utilization management 

  • Prior Authorization
  • Drug Quantity Management
  • Specialty Step Management
  • Clinical Guidance 

Plan design

  • Tier Copayments
  • Network Design
  • Zero Retail Fills
  • Drug List Recommendations 

Specialty Pharmacy and Distribution

While managing costs is often top of mind for plan sponsors, we know that clinical care, safety and service for patients are also important. Accredo, the Express Scripts specialty pharmacy, offers personalized care and access to medications for patients with chronic, often serious health conditions.



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