Medicaid Health Plans of America


Nov 11 - 13, 2015


Washington, DC


Rochelle Henderson, PhD

Monalisa Mohanty, DPh, MBA

The Hidden Threat: Managing Specialty Medications in the Medical Benefit

It’s no secret: specialty medications, for patients with complex, chronic conditions, are expensive. And, there are particular challenges and opportunities in managing specialty medications for managed Medicaid plans. Less than 1% of the population use specialty medications, yet these members account for 38% of total drug spending and also require the most personalized care and counseling to manage the unique needs and complex medication regimens.

By 2019, specialty medications are expected to reach 50% of total spending on prescription drugs. Adding to the problem, nearly half of all specialty medications are currently billed through the medical benefit, which lacks the aggressive cost-control strategies and oversight of the pharmacy benefit.

This conversation goes beyond the pharmacy benefit to address aggressive management of medically billed specialty drugs – which, if not controlled, could otherwise lead to millions in wasteful spending by next year. Applying the cost control techniques available to payers in the pharmacy benefit to the medical benefit can help reduce or eliminate this waste.

Join Express Scripts’ experts, Rochelle Henderson, PhD, Senior Director – Research and Monalisa Mohanty, Senior Clinical Director – Specialty Solutions, as they share the biggest impacts to Medicaid specialty drug trend, and offer strategies and best practices for helping managed Medicaid plans better manage specialty medication spend within the medical benefit.