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Incentivizing Specialty Generics Can Save Both Plan Sponsors and Patients Thousands of Dollars

April 15, 2020

Specialty medications continue to be a predominant topic in the healthcare industry as more novel drugs are developed. Even though only a small percentage of Americans use specialty medications, it is anticipated that they will account for half of all drug spend this year.1

Like traditional medications, there are now FDA-approved specialty generic alternatives to some expensive branded specialty medications, with many at less than 40-50% of the brand drug cost.2 As patents expire for blockbuster specialty drugs, the savings potential of converting patients to the specialty generic will continue to grow.

Less than half of specialty patients are using the specialty generic alternative, leaving thousands of dollars in potential savings on the table.3

There are a variety of reasons for this lack of conversion to the generic alternative, such as fears about effectiveness, brand loyalty and copay assistance programs. Yet, when patients, and prescribers, choose to use generic specialty medications, the possible savings for both the plan sponsor and member are significant.

Our Approach Protects Your Plan and Members from Rising Specialty Drug Costs

EnvisionRx’s approach to specialty generic medications offers a financial incentive to use the less expensive alternative, while educating the patient about specialty generics. Through our process, we thoughtfully identify clinically effective generic specialty drugs with the greatest potential to positively impact plan sponsors by reducing drug spend. This protects payers and patients against rising specialty drug costs.

With our approach, patients benefit from a $0 copay when they fill these high-value generic specialty medications. Even if the patient is eligible to receive manufacturer copay assistance, this $0 copay can be an incentive to switch to the specialty generic because it is consistent, no hassle and doesn’t expire. The plan sponsor saves because the total amount they pay for the specialty generic—although it’s 100% of the drug cost—is significantly less than the cost for the branded drug.

Sample Drug Spend for a Specialty Medication Using Our Approach:

updated specialty generic savings example

If a patient does not switch to the specialty generic, the plan sponsor is protected from unnecessary drug spend and pays just the generic cost. The patient pays their copay ($50 in the example above), plus a dispense as written (DAW) penalty in the amount of the difference in cost between the brand and generic medication. This DAW penalty will not apply to their maximum out-of-pocket (OOP) costs, making the financial incentive to switch even stronger. When clients adopt this product, EnvisionRx educates the patient about the benefits of using generics so they can make an informed decision about using the generic alternative and their OOP costs, and minimize any disruption to therapy.

Our approach to specialty generics helps commercial clients* mitigate the rising costs of specialty medications by incentivizing the use of the clinically equivalent generic, lowering spend for both the plan sponsor and patient.

*This program cannot be used by Medicare plans and generally cannot be used with Medicaid plans, but may vary by state.

1 2018 Trends in Specialty Drug Benefits, PBMI.
2 What's the difference? Biosimilar and generic drugs Retrieved from:
3 Internal data


Download our infographic to learn more about how we can reduce specialty drug spend by thousands of dollars for you and your members.

specialty generic infographic image_v3