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Thought Leadership

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The Rise of Specialty Benefit Managers: What Pharma Should Know

By Steve Callahan

In the shift toward value-based care, more payers are outsourcing the management of specific therapeutic areas to third-party specialty benefit managers (SBMs). These companies help payers manage high-cost, high-complexity disease states by leveraging provider networks and making coverage recommendations intended to improve outcomes and lower cost.

What does the growing prevalence of SBMs mean for pharma companies? To find out, MMIT’s Biologics & Injectables Index team conducted research with 35 payers covering 116 million commercial lives. We found that payers representing almost half of those lives (44%) are already engaging with third-party specialty benefit managers for at least one therapeutic area.

Let’s dive into the data to better understand the implications of this trend for manufacturers.

The Wide-Ranging Impact of SBMs

Six therapeutic areas in particular—mental health, neurological disorders, diabetes, oncology, immunology and rare diseases—are significantly impacted by the use of SBMs. For each area, at least 74% of the 50.5 million commercial lives covered by these payers is under SBM guidance.

therapeutic-areas-impacted-by-specialty-benefit-managers

Over the next few years, learning how to identify, approach and persuade these SBMs will become a much larger part of pharma companies’ launch plans and market access strategy. Manufacturers in therapeutic areas with high SBM adoption might need to consider contracting with these companies for preferential access, including formulary placement and medical policy and care path inclusion.

Read the full article in Fierce Pharma. For insights into payers’ relationships, geographic reach and other attributes, learn more about MMIT’s Payer Landscape solution.

© 2024 MMIT
Steve Callahan

Steve Callahan

Steve Callahan initially got his start conducting research in biology but transitioned his focus to Market Access as a consultant at firms such as Compass Strategic Consulting, Certara Evidence and Access, and IQVIA, and most recently as a senior manager leading market research for MMIT. Steve has conducted extensive research and has led a variety of projects within immunology and with biosimilars. Steve earned his B.S. in biology at Fairfield University, his M.S. in biology at Southern Connecticut State University, and his M.B.A. at the University of Connecticut.

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