PCRx Specialty Carve-Out

A Direct Way to Manage High-Cost Drugs

0%+

50%+ of total drug spend can come from specialty pharmacy.

$0K–$0K

GLP-1 drugs are the fastest growing single cost driver, with $8K–$15K estimated annual cost per user.

< 0%

Fewer than 2% of members can drive more than half of total plan costs.

In addition to the extreme prices, employers also face:

Complex medication approval requirements.
Limited visibility into other funding opportunities.
Higher exposure from a single therapy.
Added administrative strain for members and internal teams.

Discover New Cost-Savings

Point C helps reduce specialty drug costs while keeping the member experience supported and clear.

Explore an Alternative Approach

$17M

sourced in free specialty drug medication over 3.5 years

Step 01

Review Specialty Utilization

Point C identifies where specialty medications are driving plan costs and where carve-out opportunities may exist.

Step 02

Evaluate Alternative Funding

Eligible therapies are assessed for other funding opportunities that can reduce employer cost.

Step 03

Support the Member Experience

Members receive nurse guidance and coordinated support to help them move through requirements, approvals, and next steps.

Step 04

Manage Ongoing Administration

Point C helps coordinate the operational side of the program so employers don't carry the full burden internally.

Delivering Value Across the Plan

For Brokers

Brokers get a concrete solution to bring to clients dealing with rising specialty costs. It moves the discussion beyond general pharmacy savings and into a strategic, defined model with measurable impact.

Brokers >

For Employers

Employers gain a more disciplined way to manage one of the most volatile areas of plan spend. Instead of treating specialty expense as fixed, they can evaluate a program built to lower net cost on eligible medications.

Employers >

For Members

Members are supported throughout the process. Nurse guidance helps them understand what is required, what comes next, and how to stay connected during treatment.

Members >

Frequently Asked Questions

What is a specialty pharmacy carve-out?

A specialty pharmacy carve-out is a strategy that removes eligible specialty medications from the standard pharmacy benefit and manages them through a separate funding and administration model.

How does a specialty pharmacy carve-out reduce costs?

It reduces costs by identifying eligible high-cost medications, evaluating alternative funding opportunities, and managing those therapies through a more targeted process than a traditional pharmacy arrangement typically allows.

What kinds of medications are typically evaluated?

Programs like PCRx typically focus on high-cost specialty medications where alternative funding pathways may be available and clinically appropriate.

Specialty Drug Costs Need a Targeted Strategy