Specialty Coverage Under the Medical Benefit.
Specialty drugs are managed not only under the pharmacy benefit, but under the medical benefit as well. Specialty medications represent 50% of all drug costs for the pharmacy and medical benefits combined. By utilizing both benefits, we ensure the right drug is administered in the most cost effective, timely and convenient manner for our members, physicians and customers. The results? Reduced costs for our clients, less disruption and more convenience for members.
How do we decide which benefit is best for managing specialty drugs?
We choose whether we cover a medication under the pharmacy or the medical benefit based on a combined network, clinical and benefit model that is ideal for the member and cost.
By managing certain medications under the medical benefit we can reduce waste, delays in treatment, and improve the clinical support necessary for some acute specialty conditions. By evaluating each drug and condition, members receive the best care for their specific condition.
UnitedHealthcare also manages more than 8 million fully insured lives. Why is that important? We share your goals to lower cost where possible and provide an affordable, quality benefit. This motivates us to manage specialty drugs under the most appropriate benefit.