Two Strategies for Specialty Drug Savings—and How to Choose the Right One

Specialty medications are redefining clinical capabilities. Yet the affordability of such drugs is driving concerns across all stakeholders. Drug companies raised prices on about 872 medications in 2026, creating a median increase of about 4%.¹ These price increases affect which drugs insurers and pharmacy benefit managers (PBMs) choose to cover, ultimately impacting medication access for employer-sponsored patients.

One option gaining traction is the use of alternative funding programs (AFPs), which some employers have adopted to provide employees with access to a narrow set of high-cost specialty drugs through nontraditional pathways, such as manufacturer-assistance programs or alternative sourcing arrangements.² Another pathway is in-benefit optimization, which allows prescribers and specialty pharmacies to prioritize savings within existing channels by eliminating inefficiencies. When applied with clear boundaries, both options can pave the way for stabilized, defensible savings.

In a pharmaceutical market defined by price escalation and shifting coverage decisions, alleviating affordability concerns requires defining what employers need from their savings strategies and which options are readily available for plan sponsors to adopt within existing PBM workflows.

What Are the Non-Negotiables of Sustainable Savings?

The most convenient prescription cost reduction strategies share commonalities, such as:

• Preserving therapy and regimen continuity
• Eliminating excessive administrative duties for both prescribers and members
• Operating within regulatory and compliance industry standards
• Producing measured, defensible savings

To achieve savings that incorporate these considerations, organizations should examine multiple widely available retrenchment options. One such option is a program that directly addresses the high-unit costs of specialty drugs.

When Does Unit-Cost Become the Problem?

When a small number of drugs drive disproportionate spend, plan sponsors may turn to AFPs. With AFPs, PBMs can reduce the costs of specialty medications while lowering patient out-of-pocket expenses. These programs have the potential to address underinsured individuals who may not be able to afford the copays for chronic or life-saving medications without external sourcing.

However, while AFPs offer viable options for employers (and patients) to mitigate substantial costs, they do require significant coordination to administer access and distribute operational responsibility. Plan sponsors considering these methods should weigh the associated tradeoffs.

These programs often rely heavily on vendor activity, meaning timeliness and communication fall onto multiple parties to fill prescriptions. Alternative funding structures also increase documentation requirements, thereby exacerbating prescriber workload to maintain therapy continuity. PBMs must, therefore, establish clear guardrails to preserve audit defensibility, maximize savings benefits, and ensure patient well-being.

However, if PBMs want to operationalize savings without exacerbating current workloads, there are alternatives. Savings programs that improve efficiency within existing pharmaceutical channels could offer similar benefits without adding unnecessary risks.

Savings Within the System

In-benefit optimization allows for “in-house” savings within conventional pharmaceutical channels. PBMs achieve these savings by reducing waste and inefficiencies within existing pharmacy benefits.

Drug waste and inefficiencies typically occur in the following areas:

• Duplicative or overlapping therapies that aggravate costs without improving patient outcomes
• Oversupply, early refills, and unused medications
• Missed opportunities for lower-cost alternatives (that are already available in-network)
• Overly complex patient regimens that exacerbate adherence

This in-benefit optimization approach enables physicians to maintain continuity of care by emphasizing execution within preexisting PBM workflows and carrier structures, regardless of the funding model. This model contrasts with other savings approaches, where staff may need to connect with multiple points of contact to administer drugs.

When plan sponsors establish clear boundaries, AFPs and in-benefit optimization can effectively address small (but necessary) spending concentrations and broader, long-term cost reductions.

How to Layer Savings with Intention

To operationalize meaningful savings without adding unnecessary risks, PBMs should consider employing these steps:

1. Locate specialty spend concentrations: Identify which drugs, therapies, or conditions are causing excessive spending, then verify whether each case is used appropriately.
2. Assess for signs of waste: Look for duplication, oversupply, regimen complexity, and overlapping therapies that indicate whether avoidable refills are occurring.
3. Weigh benefits against flaws: Evaluate time-to-therapy, communication, and continuity impact when instituting durable savings approaches.
4. Prioritize prescriber workflows: Implement approaches that assist clinical workflows and clinician decision-making.
5. Make regulations a priority: Ensure selected strategies are easily defendable to auditors and regulators.
6. Track patient impact beyond the price tag: Track program adherence, compliance, complaints, and escalations in addition to net costs.

These steps assist plan sponsors in proactively identifying where their approach performs well and where a more careful path may be needed, preparing them to make informed decisions.

What Is the Path Forward for Plan Sponsors?

Given the affordability crisis straining the pharmaceutical market, the question is not whether to implement cost-saving measures, but how to do so while protecting continuity of care.

In-benefit optimization aims to implement cost-reduction efforts within existing clinical workflows, enhancing consistency with regulatory compliance and meeting administrative demands. AFPs support financial management of high-cost specialty drugs but often require greater documentation and communication between parties.

Plan sponsors should evaluate all savings approaches and incorporate aspects of each plan that encourage clinical appropriateness and continuity of care, while protecting the overall benefit and member experience. When thoughtfully structured, these models can reduce cost volatility while promoting broader system stability, allowing employers, PBMs, and plan sponsors to better anticipate pharmaceutical spending without compromising defensible continuity.
Ryan Czado is the chief pharmacy officer at RazorMetrics.

References

1. Lupkin S. Many brand-name drug prices are going up, despite Trump administration deals. NPR. January 14, 2026. Accessed May 4, 2026. https://www.npr.org/2026/01/14/nx-s1-5669401/many-brand-name-drug-prices-are-going-up-despite-trump-administration-deals
2. National Community Oncology Dispensing Association. Alternative funding programs: implications for patient care. NCODA. Accessed May 4, 2026. https://ncoda.org/news/alternative-funding-programs-implications-for-patient-care/