OBJECTIVES:  To evaluate the effect of a real-time, multidisciplinary medical benefit management (MBM) program for specialty drug on utilization and cost. METHODS: A holistic end-to-end MBM program for specialty drugs was implemented by a Medical Services Organization (MSO) that manages multiple independent practice associations (IPAs) in Southern California which are at financial risk for specialty drugs. Specialty drug requests were evaluated by a team of medical specialists, sub-specialists and clinical pharmacists using nationally recognized evidence-based guidelines and peer-reviewed journal publications. Clinical recommendations were provided to the payor for final approval. Claims from the MSO were collected to analyze the specialty drug spend before and after MBM program implementation during the period from 2014 to 2016. A dollars spend per-utilizer-per-month (PUPM) metric was applied for the comparison of medication utilization. All dollar values were reported in 2016 terms. RESULTS: