Own the Outcome: Employers Hold the Key to Specialty Drug Management Success
What Employers Need to Look Out For in the Specialty Drug Market in 2025
The specialty drug market in 2025 will continue to be a dynamic, high-stakes environment marked by rising costs, rapid innovation, and increasingly complex supply chains. For employers providing health benefits, this space presents both challenges and opportunities. However, one undeniable truth remains: employers are directly responsible for how they purchase drug management services, and their decisions have a profound impact on both cost and outcomes.
The Challenge of Information Asymmetry
One of the most significant issues employers face is the pervasive information asymmetry between themselves and the vendors they rely on, such as pharmacy benefit managers (PBMs) and health plans. PBMs and health plans are sophisticated intermediaries that operate with far more data, expertise, and market insights than the employers they serve. This imbalance often leads to decision-making that—intentionally or not—fails to prioritize the employer’s best interests.
Employers must acknowledge this gap and take deliberate steps to bridge it. Without a strategic understanding of the specialty drug market, employers risk perpetuating opaque, non-transparent business models that drive inefficiencies, inflate costs, and erode value.
The Role of Employers in Perpetuating the Status Quo
While the shortcomings of the PBM industry are well-documented—hidden rebates, conflicts of interest, and misaligned incentives, to name a few—employers themselves play a critical role in perpetuating this flawed system. Too often, employers:
Default to Vendor-Led Solutions: Employers rely on PBMs and health plans to design and manage their pharmacy benefits without ensuring those solutions align with their specific objectives.
Lack Internal Expertise: Many organizations lack the in-house expertise needed to critically evaluate vendor proposals, monitor performance, and negotiate favorable terms.
Fail to Demand Transparency: Employers often accept opaque pricing models and rebate structures, foregoing opportunities for greater accountability and cost savings.
In short, while it is easy to blame PBMs for the industry's lack of transparency, employers must also take responsibility for their role in sustaining this system.
Steps Employers Must Take in 2025
To navigate the specialty drug market effectively and align benefit strategies with organizational goals, employers should consider the following:
Invest in Aligned Expertise: Employers need trusted advisors with deep knowledge of specialty drug management, independent of vendor interests. These experts can help bridge the information asymmetry, ensuring decisions are informed, strategic, and aligned with organizational objectives.
Prioritize Transparency: Employers should demand full transparency from PBMs and health plans, particularly regarding pricing, rebates, and administrative fees. Transparent agreements enable employers to understand the true cost of services and ensure they are receiving value for their investment.
Leverage Data Analytics: Advanced analytics can uncover patterns in drug utilization, identify cost-saving opportunities, and measure the effectiveness of existing programs. Employers should insist on having access to and control over their data to make informed decisions.
Rethink Contracting Strategies: Contracts should be structured to align PBM incentives with employer objectives, such as reducing costs and improving patient outcomes. Performance guarantees, pass-through pricing models, and regular audits are essential tools.
Engage in Collective Action: Employers can strengthen their position by collaborating with coalitions, associations, and other organizations to advocate for policy changes and negotiate better terms with vendors.
The Future of Specialty Drug Management
The specialty drug market is evolving rapidly, driven by a surge in approvals for complex, high-cost therapies. Employers must adapt to this changing landscape by taking ownership of their pharmacy benefits strategy. This means moving beyond passive reliance on vendors and actively participating in the design and oversight of their drug management programs.
By acknowledging the information asymmetry inherent in the current system and taking proactive steps to address it, employers can break free from the status quo and create a model that prioritizes transparency, accountability, and value. The responsibility is theirs to lead the change—and the time to act is now.
Axum Rx: Redefining Trust and Value in Specialty Drug Management
At Axum Rx, we pride ourselves on being a trusted, independent partner to employers navigating the complex specialty drug landscape. Founded and led by experienced pharmacists, our mission is to elevate the patient care experience while driving measurable outcomes and addressing inefficiencies.
Unlike traditional players in the industry, Axum Rx operates without conflicts of interest, ensuring that our recommendations and strategies are aligned solely with the goals of employers and the well-being of their employees. We focus on reducing wasteful and unoptimized spending by leveraging our deep expertise in specialty drug management, advanced analytics, and a patient-centered approach.
Together, we aim to create a transparent, value-driven healthcare ecosystem that delivers better care, improved outcomes, and significant cost savings for employers and their members. Contact us to learn more.