How much do specialty drugs add to your plan?
A small number of members on specialty drugs can drive a large share of claims. Enter your group to see how exposed you are.
Specialty drug exposure
Enter your covered members, the share using specialty drugs and the typical annual drug cost.
Your estimate
Estimates only. Results depend on the figures you enter and on your plan documents. Not tax, legal or financial advice.
Why specialty drugs matter
Specialty drugs treat complex conditions and can cost tens of thousands of dollars a year per person. A handful of users can account for a large part of your pharmacy spend.
What you can do
Review how your plan manages specialty drugs, whether lower-cost sources are available and how stop-loss treats pharmacy claims if you are self-funded or level-funded.
Common questions
What counts as a specialty drug?
Usually a high-cost medication for a complex or chronic condition that needs special handling or monitoring. Each plan has its own list.
Can I lower the cost?
Sometimes. Options include alternative sourcing, copay programs, step therapy and a different pharmacy benefit design.
How does stop-loss treat these drugs?
Terms differ by policy. Some contracts limit or exclude certain drugs, so read the language.
Does a small group feel it more?
Yes. With fewer members one claimant is a larger share of claims.
Talk to us about your numbers
Book a 30-minute call and we will check these figures against your plan, your carriers and your goals. Visit us at 41000 Woodward Avenue, Suite 350 East, Bloomfield Hills, MI 48304, or call 248.370.8853.
Unhappy With Your Current Broker?
Switching to CFH takes one signed letter. Your carrier, plan, ID cards and payroll deductions stay the same.
Related guides and tools.
Health and Cost Strategy
How we manage plan cost without cutting coverage.
Free Employer Benefits Tools
The full set of free calculators for employers.
Renewal Second Opinion
Send us your renewal and we will check it.
Rate Guarantee Value Calculator
Estimate what a multi-year rate cap could save.
Level-Funded Surplus Refund Calculator
Estimate the year-end refund on a level-funded plan.
Carrier Switch Savings Calculator
Compare multi-year premiums net of switching costs.
An independent employee benefits consulting firm. We look at the entire benefits program — cost, plan performance, risk and administration.
Switch to CFH. Unhappy with your broker? Your employees won’t notice. You will. →