2025 Trends in Specialty Pharmacy Billing Services You Need to Know

There is no doubt that today, the field of specialty medication is in high demand due to the increase in specialty medicine and advanced technology. And hence, undoubtedly, with this increase, specialty pharmacy billing demand is also increasing. Be it the increase in the usage of biosimilars, to the integration of medical and pharmacy claims, these shifts would surely make a difference in billing, administrative workflows, and patient outcomes. This is why it is important that you have a professional by your side who is aware of the growing trend and is expert in managing your specialty pharmacy billing services.

Trends in Specialty Pharmacy Billing

Higher Use of Biosimilars – In 2025, a new trend is rapidly gaining momentum viz. the rise of biosimilars, like Ustekinumab (Stelara). Being similar products, more affordable than their original counterparts, they are significantly impacting compensation rates and billing processes in specialty pharmacies. By offering cost savings, biosimilars are anticipated to improve reimbursement rates, as payers are increasingly likely to favor them over branded alternatives. Adapting to this shift can bring significant benefits to your pharmacy. And for that specialty pharmacies across the US need to make certain billing changes and other adjustments like:

• Adapting to medical vs. pharmacy benefits: Do you know traditionally, many biosimilars are billed under the medical benefit since they are administered in clinics? However, with the rise of self-administered biosimilars, they need to be billed under pharmacy benefit. Specialty pharmacies must update their billing processes to accommodate these differing benefit structures.
• Being up-to-date with the latest codes – As you know, running a seamless specialty pharmacy billing practice successfully requires being constantly updated on every new code, and with the latest introduction of biosimilars, you need to be further alert.
• Handling effective specialty pharmacy prior authorization – With the new chapter of biosimilars, patient will require more authorization. This is why you need to have a strong understanding of pre-auth requests and how to manage pre-authorization denials and reauthorizations.

Additionally with Pharmacy Benefit Managers (PBMs) facing increasing pressure to make rebate and pricing structures more transparent when managing billing operations, you need to be more careful. This transparency can build patient trust and improve healthcare cost management, among other things. By partnering with an RCM expert like us, you, in short, do not have to worry about any billing or coding issues related to specialty pharmacy claims anymore.

How Sunknowledge Can Help Your Specialty Pharmacy Billing

We are professional billers who have been helping many leading pharmacies across the US with better revenue, lesser claim-denials, and improved billing – all at an extremely cost-effective rate. Partnering with us can help you with:

• Effective data management – With a team of skilled billers, we ensure accurate patient-data is recorded so you do not have to face billing errors due to missing particulars like the social security number, or the name, or details of the patient’s medical history. In fact, we further offer doctor’s office follow-ups so you can relax and ensure uninterrupted patient-care while we take care of all your administrative requirements.
• Fewer billing errors – With our stringent checks and balances, we guarantee an almost 99.9% accuracy in our billing and coding processes. We also have testimonials across the US from specialty pharmacies regarding our billing accuracy.
• Faster and easy prior authorization – With a team of prior auth professionals taking care of all your authorization initiations, approvals and follow-ups, we ensure faster authorization approvals. Submitting 100% PA requests on the same day, we guarantee zero backlogs and minimized delays in getting approvals.
• Streamlined claims process – Our seamless billing process, with a practically zero error rate, helps in processing claims more effectively. While verifying claims promptly, with us, you further experience a reduced rate of claims getting delays and rejected.
• Better ROI – With better billing operations in both pre and post-specialty pharmacy billing, we help in generating better ROI in no time.
• Dedicated resources – We provide dedicated billers and coders working on your account to cater to your billing needs, unlike other RCM companies who tend to assign shared resources who work on multiple accounts simultaneously.

Taking care of all complexities of specialty pharmacy billing, we also have excellent references across the US for specialty pharmacies. If you are looking for a seamless billing operation and a sustained growth of your practice, call our experts and experience the change today.