Seize the Opportunity to Control Your Specialty Drug Spend

Posted by Navitus Health Solutions on Oct 14, 2021 6:00:00 AM

Provider-administered specialty drugs covered under the medical benefit can cost far more than their average wholesale price (AWP). As a result employers that fail to manage their medical specialty drug spend risk overspending.


If your organization covers specialty drugs under the medical benefit, consider these questions:

  • Do you know how much you are spending on specialty drugs under your medical benefit?
  • Do you know if your members are receiving their infusions at the most convenient and cost-effective sites of care?
  • Do you know the approval rate of prior authorizations for specialty drugs under your medical benefit?
  • Do you know if you are receiving manufacturer discounts for specialty drug utilization under your medical benefit?

If you answered “no” to any of these questions, then our Medically Administered Pharmacy (MAP) Formulary is tailored for you. Navitus’ innovative MAP Formulary is created exclusively for physician-administered specialty drugs, helping employers manage this hidden side of specialty drug spend.

With nearly 40% of specialty drug spend occurring under the medical benefit, it is imperative for employers to manage this part of their drug spend in order to control their specialty drug costs.1 Specialty drug prices can vary wildly under the medical benefit, being subject to provider charges that are as much as 10 times the AWP. Even in the case of more modest hospital or physician charges, employer costs under the medical benefit are often still double to triple that of Medicare reimbursement rates.2


Our MAP Formulary helps employers minimize their risk of overspending by managing their medical specialty spend under our lowest-net-cost pharmacy benefit. When you add our turnkey MAP Formulary to your Navitus pharmacy benefit, you unlock the following tools to manage your medical specialty drugs:

Cost Transformation

Substitute the uncertainty and high variability of buy-and-bill reimbursement with a specialty pharmacy network featuring pass-through discounts based on drug list prices, not provider charges.

Value: Cost transformation savings can approach $10 PMPM.

Site of Care

Gain access to more convenient and cost-effective alternative options for your members to receive their specialty drug infusions.

Value: Single member site-of-care transitions can save over $1 million annually.

Medical Prior Authorization

Apply Navitus’ lowest-net-cost approach to your medical specialty drugs while ensuring clinically appropriate utilization.

Value: Navitus’ prior authorization approval rate for medical drugs in 2020 was under 70%.

Preferred Products

Earn additional discounts when you utilize certain preferred, lowest-net-cost medical specialty products.

Value: Biosimilars can cost 10-57% less compared to their originators.

The time to take control of all your specialty drug spend has arrived. Contact your Navitus account representative or email to get started.


  1. State of Specialty: Spend and Trend Report. Pharmaceutical Strategies Group. Published October 2020. Accessed March 8, 2021
  2. Navitus internal data.

Topics: Insider, Specialty

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