For the past five years, MBGH's groundbreaking work in examining the value-based purchasing activities of employers identified specialty pharmacy as a major challenge and focus for employers who must manage the higher cost of care associated with the specialty drug environment. These challenges include the increasing number of biologic and specialty drugs being produced for a number of rare and chronic conditions. Employers need to address the high cost of waste that results from patients disposing of drugs due to side effects, medication adherence, site of care issues, inadequate consumer education and more.
What is the National Employer Initiative
on Specialty Pharmacy?
Increased interest with employers who better understand the extent, scope and management of biologics/specialty drug use in covered populations is significant. While most research and industry information has focused on third-party market survey results or PBM marketing of their specialty pharmacy programs, this initiative brings forth real world learnings from the employer perspective that supports more effective partnerships with PBMs and addresses contract transparency issues and benefit plan design strategies that focus on driving optimal patient outcomes.
MBGH’s August 2014 Annual Employer Member Survey cited “Managing Specialty Pharmacy” as one of the top benefits management priorities. This underscores the need for a national Call to Action for self-funded plans to examine the many challenges and issues, while serving as a valuable opportunity to establish an accurate roadmap towards implementing effective benefits and coverage strategies in the future.
This project has been developed by employers for employers, and continues to be guided by:
- An Employer Advisory Council consisting of high-level human resources and health benefits professionals who represent large, self-insured, public and private employers.
- National annual surveys focused on specialty drug management and key trends.
- An online toolkit - www.specialtyrxtoolkit.com - offering key knowledge and resources to support employers.
- Annual multi-stakeholder meetings represented by employers, employer coalitions, PBMs, health plans, specialty pharmacies, consulting firms, patient advocacy representatives and pharmaceutical manufacturers - covering all facets of the specialty pharmacy environment.
- Frequent educational outreach through national conferences.
- National employer pilot projects with six employer coalitions focused on the following benefit coverage approaches:
- Ensuring High-Quality Case/Care Management and Coordination with Medical and Pharmacy Plan Vendors
- Improving Treatment Adherence and patient therapy engagement
- Using Value-Based Benefit Design: Higher Value Medications At Lower Cost Share (e.g., lowest cost for best outcome)
- Incentivizing Patients to Use Specialty Pharmacy
- Using Limited Fill Supply Plan Design Options (e.g., 7-10 day first fill on new prescription)Using Step-Therapy Strategy to Improve
- Clinical Outcomes and Medication Compliance
Employer-Focused Benchmarking Surveys are completed on an annual basis to provided an in-depth review of the employer's perspective of the specialty pharmacy environment.
2014 Results - Employers Still Trying to Find Right Strategies for Specialty
2013 Results - Employers Become Savvier about Biologics and Specialty Drugs
2012 Results - Research Continues to Show Employers Low Level of Understanding
View Poster Presentation for 2014 AVBCC Conference
Employer Toolkit on Specialty Pharmacy Benefits (launched January 2013 - www.specialtyrxtoolkit.com)
This MBGH toolkit will provide employers with information, best practices, and resources in the following areas:
(1) Specialty Pharmacy 101: Assists employers in better understanding the basics and economics of Specialty Pharmacy and related benefits
(2) Managing Specialty Benefits: Supports employers in effectively contracting and partnering with their PBMs, Health Plans and Specialty Pharmacies
(3) Supporting At-Risk Populations: Helps employers understand the importance of managing their at-risk populations and communicating specialty benefits to their covered population
View Toolkit Site Map
For more information on this initiative, contact Cheryl Larson, Vice President