Managing Specialty Drugs

Managing
Specialty Drugs

Background

In 2010, MBGH embarked on an multi-year journey to help employers better understand the challenges and opportunities in effectively managing specialty drug costs and patient outcomes. The August 2014 MBGH Annual Employer Member Survey cited “Managing Specialty Drugs” as one of  the top benefits management priorities.

Each year, there is an increasing number of biologic and specialty drugs being produced for a number of rare and chronic conditions. With more specialty drugs coming down the pipeline and faster drug approvals, employers are seeking to identify various management strategies that support the health and productivity of their workforce and positively impact the bottom line. Through this groundbreaking initiative, MBGH is bringing forth real world learnings from the employer perspective that will support more effective partnerships with PBMs, address contract transparency issues and determine effective benefit plan design strategies that focus on driving optimal patient outcomes.

Outcomes

Employer benchmarking for the last four years that identifies key trends, assesses the employer perspective, and shares the results of the impact specialty drugs have on an employer’s covered population.

An Employer Advisory Council consisting of high-level human resources and health benefits professionals who represent large, self-insured, public and private 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 drug environment.

Business Case for Employers

  • Estimates suggest that specialty drug costs could quadruple by 2020, reaching about $400 billion, or 9.1 percent of national health spending (UHG Specialty Pharmacy Issue Brief; April 2014)
  • At least 50% of all drugs in late-stage development today are in the specialty drug category
  • Over 900 biologics/specialty drugs are already approved by the U.S. Food and Drug Administration
  • Approximately 50%-60% of biologic/specialty drugs are represented by the oncology category
  • After regulators spent years determining a pathway for biosimilars, the first have recently been approved by the FDA (EBN March 2015)

Project Goals

  • To provide education and up-to-date information on the specialty drug environment
  • Develop an online employer toolkit that supports employers in developing innovative benefit coverage approaches for total cost of care and patient outcomes, manage costs in both the medical and pharmacy benefit, support effective contracting with vendors, and offers resources that can support consumer communications

An Employer-Driven Initiative


Employer Resources

MBGH online employer toolkit:  SpecialtyRxToolkit

Latest industry articles

Project Contacts

If you are interested in learning more about managing specialty drugs contact Cheryl Larson or Denise Giambalvo