Medicare Embraces Site-Neutral Payments. Why Haven't Employers?

By Bryce Platt, PharmD Provider-administered drugs are one of the fastest-growing and least-managed cost drivers for commercial plan sponsors. Despite that, recent data from the Pharmaceutical Strategies Group show that only 35% of commercial plan sponsors currently have a site of care (SOC) program in place for specialty pharmacy. That result is surprising given the size of the savings at stake. Medicare has figured this out and started site-neutral payments over a decade ago, but the employers who fund the bulk of commercial health spending largely haven't. The evidence supporting SOC management is no longer the story. The real question…

By Bryce Platt, PharmD

Provider-administered drugs are one of the fastest-growing and least-managed cost drivers for commercial plan sponsors.

Despite that, recent data from the Pharmaceutical Strategies Group show that only 35% of commercial plan sponsors currently have a site of care (SOC) program in place for specialty pharmacy. That result is surprising given the size of the savings at stake.

Medicare has figured this out and started site-neutral payments over a decade ago, but the employers who fund the bulk of commercial health spending largely haven't.

The evidence supporting SOC management is no longer the story. The real question is why so many commercial plans continue paying hospital prices when lower-cost alternatives already exist.
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