The National Employer Initiative on Specialty Drugs project was launched to bring forth real world knowledge, research and benchmarking to support employers in:
- Understanding what biologics and specialty drugs are and how they can manage costs more effectively
- Implementing innovative benefit coverage approaches focused on total cost of care and patient outcomes
- Identifying and addressing specialty drug use in the medical and pharmacy benefit
- Optimizing PBM contracts to address transparency, pricing and rebates
- Developing more effective partnerships with pharmacy benefit stakeholders
- Gaining knowledge, guidance and access to no-cost resources to support plan performance
- Removing inappropriate waste from PBM and health plan contracts related to specialty drugs
Key project elements include:
- Employer Advisory Council consisting of representatives from large self-insured employers
- Annual Employer Benchmarking Surveys
- National Educational Outreach – programs on specialty drug management have been presented across the country
- Employer Coalition Collaboration – sharing employer-driven research from and open collaboration with sister coalitions of the National Alliance of Health Care Purchaser Coalitions (formerly National Business Coalition on Health) nationalalliancehealth.org:
- Employers Health Coalition – Arkansas
- Employers Health Coalition – Ohio
- Florida Health Care Coalition – Florida
- HealthCare 21 Business Coalition – Tennessee
- Mid-America Coalition on Health Care – Kansas
- Midwest Business Group on Health – Midwest
Employer Toolkit – providing access to no-cost resources, tools and other valuable information to support employer understanding and management of specialty drugs
- Multi-Stakeholder Collaboration – Annual invitation-only meeting with employers, employer coalitions, PBMs, specialty pharmacies, health plans, pharmaceutical manufacturers and other market stakeholders to support project direction and key activities. The Multi-Stakeholder Council has identified and is working on the following issues:
Offering effective education to address the overall lack of industry knowledge on drug pricing, comparative effectiveness research and the related value of specialty drugs
Driving middleman/PBM transparency and accountability for pricing, contracting and rebates to support informed employer decision-making
Redefining quality based, economically driven and outcomes-based narrow networks – Centers of Excellence and High-Performing Networks – to ensure optimal plan performance from the employer perspective
Determining the use and value of co-pay/coupon assistance and other financial assistance programs that could have significant unintended consequences to plan members as well as plan sponsors in the post-ACA market
Integrating performance and outcomes-based guarantees into direct provider, middleman, PBM and vendor contracts
Ensuring vendors provide actionable data and real time reporting for the plan sponsor and member
Identifying value-based tools that integrate treatment guidelines to effectively address affordability and efficacy as part of the plan design strategy
Promoting available resources, including this toolkit, NCCN’s Cancer Resource Guide and sister coalition resources
Project activities include:
- Developing and refining existing resources and tools from the employer perspective to support management of specialty drugs
- Strategy and White Paper on the Impact of the Middleman on Medical & Pharmacy Costs to Self-Funded Employer Plan Sponsors
- Directional support and/or guidance for data mapping from an employer perspective
