Twenty-five percent of employers say they have little or no understanding of specialty pharmacy benefits while 53 percent say they have just a moderate understanding, according to a recent survey by the nonprofit Midwest Business Group on Health.

Of the 120 surveyed employers, which vary in size from 500 to 25,000 employees, most say they don't know how much is being spent on specialty pharmacy medications through their medical or pharmacy plans. Nearly 30 percent say they're unaware of how much their total specialty claim costs had increased over the last three to five years.

"In addition to the uncertainty and challenges that health reform and the economy are placing on employers, health plans and pharmacy benefit managers, the real driver of drug cost trend growth for employers lies in biologics and specialty pharmacy," says Cheryl Larson, MBGH vice president. "Our research confirms there is a broad lack of awareness and specific knowledge about benefit design related to specialty pharmacy that illustrates key gaps that need to be addressed."