Biologic Specialty Pharmacy

Project Scope
MBGH’s work in examining the value-based purchasing activities of employers has identified specialty drugs as a major challenge and focus for employers.  Along with the higher cost of these medications that are increasingly being produced for a rising number of conditions, comes increasing waste – ranging from inappropriate prescribing by physicians to non-compliance by patients. 

Today, there are estimated to be more than 700 biologics in the pipeline, with costs for specialty drugs expected to represent up to 40% of an employer’s total medical spend by 2020.  Although some research efforts have been conducted for specialty pharmacy, most have not explored the key elements this MBGH project seeks to target through this employer driven initiative, which include:

• Enhancing employer awareness and understanding of specialty pharmaceuticals
• Creating a “living document” toolkit available on the web to serve as an educational resource for employers
• Sharing optimal approaches for innovation in benefit plan design and vendor contracting
• Supporting employer efforts in managing and communicating with their at-risk population
• Providing educational outreach to key health care stakeholders to support collaboration and optimize patient outcomes

This entire initiative is broken down into four Work Streams. (See Work Streams Overview)  

Work Stream I: 2010 - 2012

• Establishment of an Employer Advisory Council consisting of large, national self-insured employers in Chicago and Baltimore
• Launch of a National Employer Survey on costs, current benefit offerings and best practices 
• Development of an Employer Toolkit on Biologics/Specialty Pharmacy
• Educational outreach to employers across the country

This toolkit will provide employers with information, best practices, and resources in the following areas: (1) Education & Awareness:  Assists employers to better understand Biologics/Specialty Pharmacy Benefits; (2)  Planning and Contracting:  Supports employers in effectively contracting and partnering with their Health Plans, PBMs and Specialty Pharmacies; (3) Management & Communications:  Helps employers understand the importance of managing their at-risk populations and communicating specialty benefits

View Employer Toolkit

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