Almost half of specialty drug claims occur under the medical benefit of a plan rather than the pharmacy benefit. Specialty drugs are typically administered by the provider—often intravenously—and are used for treating chronic and complex diseases. They are also notoriously expensive.

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 outlines best practices for handling specialty drug claims in a way that goes beyond prior authorization, for better accuracy and faster payment.