Specialty drugs are complex. Managed by both medical and pharmaceutical benefits, specialty drugs are typically injectable drugs administered by a provider and are used to treat chronic diseases. They are also notoriously expensive, with U.S. prescription dispensing revenues from specialty pharmaceuticals estimated at $243 billion in 2023.

Their complexity and expense make specialty drug claims especially prone to inaccurate billing, or worse, fraud and abuse. While many plans use prior authorization to handle these claims, relying solely on this process can result in limited details that can leave plans open to inappropriate claims in their payment integrity process.

In this white paper, Jonathan Starr, PharmD and Matthew Herbein outline best practices for handling specialty drug claims for better accuracy and faster payment. Read to learn:

• How to improve payment integrity efforts within specialty drug claims
• Common concerns that can result from overrelying on prior authorization
• Fraud, waste, and abuse cases within specialty drugs