We use Clinical Efficacy to reduce specialty & other high-cost pharmacy spend for plan sponsors, cutting waste on high-cost drugs that don’t produce outcomes and getting patients to the right therapy faster.

Specialty drugs are expensive.

Only pay for the ones that work.

Legacy prior authorization approves drugs. We help you determine if they actually work. By continuously assessing patient data against clinical guidelines, eliminating ineffective therapies, and “gold carding” members on the right ones, plans reduce specialty pharmacy spend, improve clinical outcomes, lower administrative costs, and deliver a far better overall experience.

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Specialty medications, including GLP-1s, can be lifesaving, but come with challenges: high costs, variable effectiveness and potential for harm.

They can also be very expensive, often ineffective and potentially harmful.

Very expensive

US new drug launch prices rose from $31,700 in 2011 to $228,700 in 2022.

In 2024, median annual cost of treatment for new drugs launched exceeded $350,000.

Often ineffective

Many specialty medications have been pulled from the market due to ineffectiveness.

Others continue to be prescribed even though the drug is not effective as measured by intended clinical endpoints.

Potentially harmful

Specialty medications also carry potential risks, such as acute liver failure (e.g. Elevidys), pancreatitis or thyroid cancers (e.g. GLP-1s) or other serious adverse effects.

Specialty Drug Spend Continues to Escalate and Accelerate

10-15%

Specialty drug costs are continuing to experience double digit increases year over year.

32%+

Expert projections suggest specialty costs will climb by at least 32% by 2028.

80%

Of top specialty drugs are showing cost increases year over year, with some experiencing 40%+ jumps

1/4

24% of members using GLP-1s had no history of any other diabetes medication before initiating GLP-1 therapy.

Statistics sourced from Pharmaceutical Strategies Group. 2026 Artemetrx State of Specialty Spend and Trend Report.

Introducing

The Ethicos Health Clinical Efficacy Platform

Leveraging our AI-enabled platform, Plans instantly convert their existing clinical guidelines into machine readable algorithms, evaluate longitudinal patient data against each medication’s intended outcome, and automate provider outreach to close data gaps and communicate results. By continuously assessing patient data against clinical guidelines, eliminating ineffective therapies, and “goldcarding” members on the right ones, plans can: