Specialty drug costs are rising—and so are expectations. From gene therapies to GLP-1s, these breakthrough treatments bring incredible promise but also demand smarter, more connected approaches to pharmacy management.
At Abarca, we’re not just responding to the shift—we’re driving it. This approach is part of Abarca’s Better Care— a solution that offers a modular system that unifies specialty, adherence, affordability, and access solutions in one seamless experience.
In this blog, we dive into expert insights from Lissette Lorenzo, Pharm.D., Abarca’s SVP of Clinical Strategy & Services, on redefining payment models, reshaping PBMs, and aligning care with value.
Smarter Payment Models for Specialty Drug Coverage
Not all therapies are created equal—and neither should be the ways we pay for them. “The right payment model depends on the condition, the therapy, and the data that supports it,” explains Lorenzo.
Abarca is leveraging a flexible payment strategy tailored to maximize impact and minimize financial risk:
Top Specialty Pharmacy Payment Models:
Annuity Payment Model
Ideal for curative therapies like gene treatments, spreading high costs over time to reflect long-term value.
Outcomes-Based Contracts
Align payment with patient outcomes—supported by clear definitions, data sharing, and timely reporting on real-world results.
Stop-Loss Programs
Provide financial protection from single catastrophic claims in high-risk populations.
Key takeaway: The future isn’t one-size-fits-all—it’s data-driven, adaptive, and outcomes-focused.
The Rise of the Clinical-First Approach
The traditional PBM model is outdated—especially in the era of specialty drugs that require high-touch, personalized support. “PBMs must evolve into clinical intelligence hubs,” says Lorenzo.
How Abarca Is Leading the PBM Transformation:
- Anticipating therapy risks with evidence-based analytics
- Tailoring adherence and affordability solutions at the point of care
- Integrating clinical and financial strategies into a single platform
One example is Better Balance, Abarca’s digital health program targeting cardiometabolic diseases like obesity and diabetes. It aligns therapy management, GLP-1 optimization, and patient support—all within one ecosystem. Additional programs like Better Access ensure patients receive the support and choice they need across the care journey.
Policy Reform & Transparency in Specialty Drug Pricing
As federal policies push for transparency in drug pricing, Abarca has already made this the standard—not the exception.
“We built programs like Better PAth with auditability and fairness at their core,” says Lorenzo. Whether addressing rebate reform or prior authorization rules, Abarca’s radical transparency model sets a new benchmark for PBMs.
This direction also reflects broader conversations happening across the industry. In a recent MedCity News article, Nicole Bulochnik, Abarca’s Senior Vice President of Drug Value Strategy, discussed how AI, analytics, and cross-sector collaboration are beginning to influence specialty drug costs—highlighting the growing role of transparency and shared data in this space.
The Payer Perspective Is Changing—For the Better
Payers are moving from asking “What’s the cost?” to “What’s the value?” This mindset shift opens the door for more value-based care models in specialty pharmacy.
Abarca gives payers the tools to:
- Customize benefit designs
- Align incentives with clinical outcomes
- Improve patient access through smarter channel strategies
“Specialty pharmacy touches every part of the care journey,” says Lorenzo. “And payers are looking for partners who can navigate that complexity with clarity.”
Final Thoughts: Redefining the Future of Specialty Drug Management
At Abarca, we believe that controlling specialty drug spend shouldn’t mean compromising on care. With intelligent platforms, innovative payment models, and a clinical-first mindset, we’re making specialty pharmacy work better—for payers, providers, and most importantly, patients.
Ready to explore a smarter approach to specialty drug management?
Discover how our smarter systems, integrated care model, and value-based mindset are redefining what’s possible in specialty pharmacy. Visit abarcahealth.com to learn more about our total care and value-based solutions.
About Abarca:
At Abarca, we believe in an Unstoppable Drive for a Better Way. Our commitment to making healthcare seamless and personalized for all drives us to innovate in AI, specialty pharmacy, and predictive analytics. By transforming challenges into opportunities, we deliver PBM like no one else: better patient outcomes and an overall revolutionary healthcare experience. Join us in shaping the future at the intersection of technology and care!