Welcome to Specialty Nexus
Specialty Drug PBM Carve-Out for Comprehensive Management in Workers’ Compensation.
3 Attributes of Specialty Drugs
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[1] Expensive
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[2] Treat Complex Conditions
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[3] Require Ongoing Clinical Monitoring
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Click to Learn More...
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3 Attributes of Specialty Drugs 〰️ [1] Expensive 〰️ [2] Treat Complex Conditions 〰️ [3] Require Ongoing Clinical Monitoring 〰️ Click to Learn More... 〰️
Specialty Nexus
Defining specialty drug management for workers’ compensation
Built on statute and backed by clinical evidence, Specialty Nexus supports all specialty conditions, workforce categories, and state coverage rules.
Nexus streamlines formulary and clinical criteria, ensures ongoing monitoring, and delivers cost savings, easy access, and better outcomes.
Specialty Nexus PBM Carve-Out
Comprehensive Clinical Management
Our program combines lab monitoring, clinical evidence, and advanced analytics to fine-tune specialty drug use and manage complex conditions. With precision and personalized care at its core, we deliver better health outcomes, smarter drug utilization, and seamless disease management.
Independent Clinical Evaluation for Specialty
Our Independent Clinical reviews deliver unbiased assessments by PharmDs outside the patient’s care team. These evaluations provide objective insights on conditions and drug therapies, supporting decisions on treatment plans and return-to-work strategies with precision and expertise.
Transitions of Care
We partner with providers to simplify transitions of care for patients with complex conditions like cancer and lung transplants. From post-acute placement to medication therapy, home infusion, and DME supplies, we ensure smooth health journey, better outcomes, and lasting continuity.
Access to Specialty Drug Products
We streamline specialty product access with hassle-free home delivery of maintenance medications and optimized workflows for home infusion and limited distribution drugs. Our Critical Access Program is designed to improve outcomes and minimize waste.
Leading the Way in Specialty Trend Management for Workers’ Compensation
Nexus sets the standard in specialty drug management, combining sustainable cost control with exceptional clinical care to deliver unmatched savings and redefine industry expectations.
Estimated Savings Through Waste Reduction and Optimization
Specialty Facts
Specialty Defined
These drugs play a critical role in treating chronic diseases and require robust clinical management due to their complexity and high cost.
Treat Complex or Rare Conditions: Often used for chronic, severe, or rare diseases such as cancer, rheumatoid arthritis, respiratory diseases.
Require Special Handling or Administration: They may need refrigeration, special packaging, or unique delivery methods (e.g., injections or infusions).
High Costs: Specialty drugs are typically much more expensive than traditional medications.
Require Ongoing Monitoring: Often require regular patient monitoring for efficacy, side effects, or dosage adjustments.
Limited Availability: May only be dispensed through specialty pharmacies or under strict guidelines.
Specialty Trends
Specialty drugs are reshaping the landscape, driving significant changes in workers’ compensation drug trends. Key trend drivers of specialty drugs include:
Rapid Growth: Specialty drugs are the fastest-growing segment of drug costs, creating a profound impact on workers' compensation claims.
Drug Pipeline: Two out of three medications currently in the FDA approval pipeline are classified as specialty drugs, reflecting their critical role in addressing complex and chronic conditions.
Small Usage, Big Impact: While specialty drugs account for just 1% of drug utilization, they represent a staggering 10% of the total drug spend in workers' compensation programs.
Future Projections: By 2030, specialty drugs are expected to comprise 18-20% of total drug spending, driven by breakthroughs in treatments for new conditions and the introduction of new medications.
High-Impact Sectors: Payers are experiencing the sharpest growth in costs among municipalities and organizations employing frontline workers, including first responders, healthcare professionals, and other essential personnel.
Discover how Prodigy is revolutionizing specialty drug management by transforming the outdated PBM model.
Specialty Updates
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Request Claims Diagnostic Analysis
Nexus Claims Diagnostic Analysis delivers a powerful review of your claims history, uncovering spend, waste, opportunities, and trends to optimize pharmacy and ancillary services.
Paired with strategic management solutions, the Nexus diagnostics helps mitigate financial and regulatory risks for payers while maximizing patient outcomes.
Valued at $12,995 and offered at no cost (subject to pre-qualification)