Executive Insights

Executive Insights: Evolving Payor Strategies to Control Spending on Specialty Medications & Implications for Health Systems

Spending on prescription drugs has increased significantly in the past decade, driven by rising costs, availability and utilization of specialty medications. The Centers for Medicare and Medicaid Services (CMS) projects retail drug spending will grow faster than other areas of healthcare spending over the next decade. Expenditures on provider-administered specialty medications covered under the medical benefit are growing even faster. As a result, payors are implementing strategies to control spending on specialty medications, particularly physician-administered drugs. These strategies often directly conflict with care delivery strategies used by hospitals and health systems, creating financial and operational challenges for providers.

Download our summary of evolving payor strategies and their implications for hospitals and health systems.