Why Employers Are Done Waiting on Specialty Drug Costs, and What It Means for Infusion Providers

Every specialty infusion claim ends with a patient deciding whether they can afford to start or stay on their therapy. Too often, the answer is no.

I’ve watched that decision play out from several seats in this industry, including on the manufacturer side, in pharmacy, and in specialty distribution.

If you run an infusion center, you already know that specialty drugs keep getting better while the system that prices, bills, and routes them has barely changed in decades. You see the strain every day in prior authorization delays, patients struggling with their cost-share, and hospital systems competing for the same patients.

What’s changed is that employers have noticed too, and many of them are done waiting for the system to fix itself.

The math behind specialty drug spend no longer works

Employers project a 9.2% median increase in healthcare cost trend for 2027, and Aon expects near-double-digit increases for a fourth consecutive year. Specialty drugs sit at the center of that growth. Roughly 1–2% of a self-funded plan’s members are on specialty infusion therapy, and that small group typically drives 10–15% of total medical spend.

Much of that cost comes from how these drugs are billed. Under the buy-and-bill model, the drug, its markup, and its administration are bundled into a single line item on a claim. A 2024 study in the New England Journal of Medicine found that provider markups on specialty infusion drugs can exceed 400%.

The employer paying the claim usually can’t see any of that. A member on Remicade for rheumatoid arthritis may generate a claim of about $6,000 per encounter. That single number doesn’t show:

• How much the drug costs
• How much the markup is
• How much comes from something else, such as unit-count errors or waste from package sizes

You can’t manage a cost you can’t see, and for most self-funded employers, specialty drug spend has been largely invisible..

Why changing the site of care isn’t enough on its own

Site-of-care programs exist for good reason. A 2026 study of 18,988 matched patients found that hospital outpatient infusion cost 41.9% more than home, ambulatory, and office sites of care, with no significant difference in adverse events.

Cost is only part of that story. Infusion appointments can last several hours, and for hospital patients, that often means a long drive and time in a busy, open-floor infusion suite, where immunocompromised patients can face greater exposure to infection.

Sites closer to home typically offer a calmer, more comfortable experience, with shorter waits and more flexible scheduling. For someone receiving an infusion every few weeks, often for years, those differences add up. Independent infusion centers have a strong value story on both fronts.

However, moving a patient to a lower-cost site doesn’t change how the drug is billed. The bundled claim follows the patient to the new site, and the conditions that created the markup still exist.

Employers are ready to try something different

Employers have moved past worrying about these costs and are starting to act on them. Some employers might implement site-of-care mandates that deny specialty drugs billed by a hospital outpatient department. A growing number are going further and rethinking how specialty drugs are billed altogether.

A transparent specialty infusion claim breaks into three visible lines:

• The drug at its true acquisition cost
• Care coordination as a flat fee
• Clinical administration on its own line

What a transparent model looks like in practice

At Leap, we built our model around that transparency. Here’s how it works when a patient is referred to a site in the Leap Transparency Network (LTN):

• Leap sources the therapy at true acquisition cost through our specialty pharmacy partners, with no buy-and-bill markup.
• The drug is white-bagged directly to the infusion site for that specific patient.
• The site is paid a flat fee to administer it.
• A dedicated Leap Care Guide coordinates treatment, helps navigate insurance approvals, schedules care, and supports the patient throughout their therapy.

Because the site never buys or stocks the drug, it carries no inventory risk and its revenue doesn’t depend on drug margin. And since every patient has a Care Guide, the coordination work that usually lands on a center’s front desk is shared.

Coordinating a single patient’s infusion requires many touchpoints across the prescriber, the payer, the pharmacy, and the infusion site, and many of those parties still communicate by fax, email, and phone.

At Leap, agentic AI workflows take on much of that work. They help our care team schedule appointments, track drug shipments, receive and process medical orders, and coordinate across our care network, all without hours of clicking and phone calls. Every workflow is supervised by our clinical operations team, and nothing goes out externally without a human reviewing it first. When patients talk to Leap, they always talk to a real person.

What we’ve seen so far

The Leap model has produced results around the patient experience that we’re really proud of, including:

• 85+ member net promoter score (NPS)
• 98% of surveyed members are satisfied (MSAT)
• 92% of members rate their Care Guide as a 9 out of 10 or higher

And that’s with a specialty drug list that now covers more than 300 drugs.

These numbers matter to infusion centers as much as they do to employers. Patients who reach treatment quickly and have a good experience are more likely to stay on therapy, and employers keep routing patients to the sites that deliver that experience.

What this shift means for infusion providers

For independent infusion centers, the move toward transparency is an opportunity worth preparing for. Here are four ways to get ready:

1. Know your true cost to deliver an infusion

Separate what it costs to administer a therapy (nursing time, chair time, supplies, and overhead) from the drug itself. Benefit administrators who know those numbers can price and negotiate with confidence.

2. Compete on access, service, and experience

When drug margin comes out of the equation, the differentiators that matter most are the ones patients feel:

• Availability
• Scheduling flexibility
• Location
• The chairside experience

3. Get comfortable with white bagging

White bagging is when a specialty pharmacy ships the drug directly to the site of care for a specific patient, and the site administers it without owning or stocking the drug. It’s a different way of working, and it also means less capital tied up in inventory. In the LTN, every therapy arrives this way.

4. Modernize how referrals reach you

Too many specialty infusion referrals still move by fax and phone. As employers and health plans route more patients to transparent sites, the centers that can accept referrals through the systems they already use will be the easiest ones to send patients to.

Building the network together

That’s part of why Leap is collaborating with WeInfuse. Participating infusion centers on the WeInfuse platform can join the Leap Transparency Network (LTN), our network of more than 300 independent sites, and accept Leap-coordinated patient referrals.

Inside the LTN, participating centers work within Leap’s transparent model:

• Therapies white-bagged by Leap’s specialty pharmacy partners
• A flat fee to administer them
• Care Guide support for every patient

WeInfuse sites are not automatically added to the LTN and must opt in to join, so being a WeInfuse customer doesn’t automatically make a center part of the LTN. Interested centers reach out to us, and our team reviews each site’s quality, credentialing, and licensure to confirm it meets Leap’s quality standards before it joins the network. From there, we walk through fit and next steps together. In the next phase, Leap and WeInfuse plan to co-design a referral integration directly into the WeInfuse platform.

If you’re a WeInfuse customer interested in joining the Leap Transparency Network, please reach out using this form. We’d love to work together to create the best patient experience.