OBJECTIVES:  A better understanding of health-plan management of specialty pharmacy (SP), SP-products and biosimilars of SP-products. METHODS:  Online survey sent to 459 US medical+pharmacy directors (MDs+PDs) on: advisor+plan information; specialty-pharmacies/pharmaceuticals, expected biosimilar coverage/restrictions/co-pays. RESULTS:  The survey was completed by 52 MDs+PDs (11.3%): 55.8% were MDs and worked for: health plans/IDNs/PPOs/IPAs=57.7% ; PBMs=9.6%; Government=3.8%; the remainder consultants. Plans were National=41.9%;Regional=34.9%;or Local=23.3%. 51% restrict Specialty Providers (SPs). SPs were: PBM-owned 45.7%; 34.8% owned by the healthplan; 17.4% independent; 10.9% hospital/IDN-owned. 65.9% of plans restricted SPs to those under contract; 6.8% only restricted SPs available through multiple SPs; 6.8% allowed any SP handling the agent. Specialty product co-pays continue to move from fixed to percentage with more plans using group+benefit design to determine the co-pay. Plans covered clinician-administered products under the medical-benefit (MB=15.2%, previously 64.3%); under the pharmacy-benefit (PB=67.4%, previously 5.4%); the remainder varied based on price and plan-design and 89.1% do not expect this to change. Biosimilar use is expected for all reference-product indications (59.5%), while 31.0% will restrict to their approved indications (31.0%). Plans expect biosimilar co-pays to be indication-based (9.5%), discounted off the innovator (45.2%); to vary based on the approval timing (33.3%) or be the only product available (21.4%). Member+provider biosimilar education will be provided through: different co-pays=68.3%; prescriber-mailings=63.4%; patient-mailings=53.7%; prescriber-calls=39.0%; and patient-calls=19.5%. Biosimilars savings are expected to be: <10% in 2017 (52.4%); 60.5% expect 10-20% by 2020; and 61.9% expect >20% by 2025. CONCLUSIONS:  Costs associated with specialty pharmacies/pharmacy products have shifted and are expected to grow and require appropriate coverage. The switch from the medical benefit to the pharmacy benefit for oral biologics and self-injected agents represents a significant change as SP management has grown. Biosimilars are expected to provide some cost growth relief but only over after the introduction of more than 2 competitive Biosimilars.