Specialty Benefit Management Group is a leading provider of pharmacy risk management services to unions, HMOs, private and public sectors. We have successfully managed specialty medications for over 4 million lives since the mid-1990s.

Specialty drugs are typically used to treat debilitating and life-threatening medical conditions such as: cancer, multiple sclerosis, rheumatoid arthritis, and other diseases. Employers and health insurers trying to control pharmacy benefit costs are finding that specialty medications are outpacing all other costs. Expenditure on specialty medications is one of the fastest-growing components of pharmacy benefits, and is projected to increase by 20% a year for the foreseeable future. At the same time, plan sponsors feel powerless to question or influence specialty-therapy prescribing despite eye-popping prices charged by manufacturers.

 

The SBMG Difference Provides Peace of Mind

  • Separation of dispensing from the benefit management and prior authorization functions.
  • Expert clinical oversight with an independent, third-party fiduciary perspective
  • Verification of medical necessity and appropriateness.
  • Conformance to established guidelines and best practices.
  • Counseling of physicians and patients to ensure proper use and administration.
  • Strictly-managed quantity limits to prevention waste and over-shipping by dispensing pharmacies.
  • Utilization of cost-effective therapies and step therapy, when appropriate.
  • Elimination of prescriber buy-and-bill incentives for high cost therapies.
  • Management of side effects to maximize patient adherence, particularly with self-administered medications.