AUSTIN, Texas--(
BUSINESS WIRE
)--Prodigy Care Services, a leader in innovative pharmacy solutions, today announced the launch of Specialty Nexus, a groundbreaking specialty drug management solution that delivers cost savings, enhanced clinical outcomes, and improved access to critical medications for workers’ compensation payers.
Spending on specialty drugs has more than doubled from $113 billion in 2016 to $237 billion in 2023. Traditionally defined by complex handling, specialty drugs are now also known for high costs and limited availability. Specialty Nexus disrupts the traditional pharmacy benefit manager (PBM) model with a cost-effective, clinically driven, and transparent alternative.
“Specialty Nexus is more than just a cost-savings initiative—it’s a commitment to ensuring patient access to essential medications while supporting the long-term sustainability of payer programs,” said Del Doherty, Pharm. D., Ph.D., MBA, MPH, CEO and Co-founder of Prodigy Care Services. “While traditional PBMs have fallen short in managing specialty drugs, our proactive approach integrates data-driven clinical oversight, streamlined access, and independent evaluation to deliver real value to both payers and patients.”
A New Standard for Specialty Drug Management
Specialty Nexus optimizes drug access and delivery through home delivery, streamlined workflows for infusion and limited distribution drugs, and waste reduction strategies. The solution includes independent clinical evaluations from expert PharmDs, offering objective insights into treatment options and return-to-work strategies.
“With recent changes in statutes, our municipal clients—especially those serving first responders—have seen a significant rise in specialty drug use. Partnering with Prodigy helps us navigate these evolving challenges. Prodigy provides access to prompt, transparent and reliable information for our clients and claims teams,” said Barbara A Sullivan, CPCU, AIC, President and Chief Operating Officer, EMC Claims Solutions.
To improve patient outcomes, Specialty Nexus ensures seamless transitions between post-acute care, home infusion, and durable medical equipment (DME) providers. The platform leverages analytics, lab monitoring, and evidence-based protocols to enhance adherence, patient safety, and cost efficiency.
Tackling Cost and Transparency Issues
The PBM landscape has long been dominated by vertically integrated entities profiting from inflated drug markups, hidden fees, and conflicts of interest. A recent FTC report found that PBM-affiliated specialty pharmacies accounted for 68% of dispensing revenue in 2023, with some drugs marked up over 1,000%.
“By decoupling specialty drug management from traditional PBMs, we remove all conflicts of interest and provide unparalleled transparency and financial accountability,” added Doherty. “This allows payers to maximize rebates, optimize drug utilization, and improve patient outcomes without unnecessary costs.”
Specialty drugs represent only 1% of total drug utilization but represent 10% of total drug spend, a figure projected to double by 2030. Specialty Nexus delivers estimated savings of up to 35% through evidence-based protocols, waste reduction, and rebate negotiation.
About Prodigy Care Services
Founded in 2020 and based in Austin, Texas, Prodigy Care Services is a healthcare services technology company dedicated to improving patient outcomes and payer efficiency. Its innovative solutions optimize pharmacy, post-acute care, and ancillary services across the workers’ compensation continuum.
For more information, visit
www.prodigycareservices.com
or call
(713) 322-6667
.