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Plan sponsors are considering different variations of separating specialty pharmacy from the pharmacy benefit manager (PBM). This may take the form of excluding certain drugs from the formulary, or even removing the specialty pharmacy function altogether. In this white paper, we address the four myths of these carve-out approaches and the impact they have:

  • Myth #1: Plan sponsors can better manage utilization with a specialty carve-out.
  • Myth #2: Patients receive equally good pharmacy care when specialty is carved out.
  • Myth #3: Specialty carve-out vendors offer a seamless patient experience with white-glove support.
  • Myth #4: Plan sponsors get better economic value with a specialty carve-out.
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