Employers Still Trying to Find Right Strategy for Specialty Drug Benefits According to Latest MBGH Survey
Poll found employer priority on reducing inappropriate use and drug acquisition costs
CHICAGO – While almost 75 percent of employers incentivize for employee use of a specialty pharmacy, there are minimal or no incentives offered for lower cost site-of-care settings such as home-based infusion or employer onsite clinics. This is among the findings of the third annual employer survey from the Midwest Business Group on Health (MBGH), one of the nation’s leading non-profit employer business groups.
“With specialty drug costs estimated to make up 67 percent of an employer’s total pharmacy spend by 2016, it’s essential that businesses focus their attention on managing this challenging benefit,” said Cheryl Larson, MBGH vice president. “Doing nothing is no longer an option. Our initiative is driven by employers for employers and is based on three years of survey findings. We’re moving to the pilot phase which is designed to focus on plan design innovation and better collaboration between employers and pharmacy benefit managers to drive improvements.”
Additional key findings:
- Awareness around specialty drug management continues to increase a little each year, with 78% of responding employers indicating an above average or high level of understanding.
- Since no industry changes are in sight to reduce drug acquisition costs, top priorities for employers include: reducing inappropriate use, improving adherence and compliance, and reducing variability between the pharmacy and medical plan design.
- Case management continues to lead the list of employer tactics to manage specialty drugs, followed by benefit coverage coordination for pharmacy and medical, and drug utilization.
- There is a lack of awareness on the use of limited fill strategies which are designed to avoid product waste via shorter initial fills that result from adverse events or ineffective treatment response.
- There continues to be a focus on traditional cost shifting strategies as a way to manage specilaty drug costs - e.g. multiple tiers, use of coinsurance, high out-of-pocket maximums - but these cost barriers can result in non-adherence to drug and treatment plans.
This is the third in a series of employer surveys on the management of specialty drugs conducted by MBGH, with guidance from Randy Vogenberg, PhD, principal at the Institute for Integrated Healthcare. The goal is to assess the level of knowledge employers have in the area of specialty pharmacy drugs and biologic products which are used to treat complex and chronic conditions such as cancer, multiple sclerosis, and arthritis. These drugs present significant cost challenges to employers, as well as logistical issues for patients, physicians, pharmacies and manufacturers, as special approvals are often required for their use, instructions on dosing and side effects, and appropriate storage and distribution.
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Survey respondents
Approximately 85 employers responded to the online survey. The top industries represented were manufacturing (38%), construction (13%) and government (12%); 87% were self-insured and 13% fully-insured. Of the respondent firms, 19% have more than 25,000 employees, 8% have 15,001-25,000, 20% 5,001-15,000, 27% 1,001-5,000, and 26% have fewer than 1,000.
About the Midwest Business Group on Health
With more than 120 member organizations, the Midwest Business Group on Health is one of the nation’s leading non-profit business groups of large, self-insured public and private employers serving as a catalyst for community initiatives to improve the quality, safety and cost-effectiveness of the health care delivery system. MBGH is an essential resource to support employers in effectively managing their health benefits through high-quality education, research, networking and benchmarking. MBGH is a founding member of the National Business Coalition on Health. www.mbgh.org
For further information about this release and MBGH, contact: Cary Conway, MBGH Media Consultant