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Employers Becoming Savvier About Biologics and Specialty Drugs
Date:1/24/2013

s very important to 86 percent of respondents and reducing inappropriate utilization is very important to 72 percent – although costs are very important, patient management is key to long-term success.
  • For current specialty pharmacy plan design 35 percent are using use traditional pharmacy design of tiers, co-insurance and/or co-pays. Only 21 percent use special tiers with co-pays and/or co-insurance – this underscores the need for benefit design innovation.
  • The majority of employers are still not offering incentives for requirements such as using a specialty pharmacy, participating in case management or adhering to medications – a missed opportunity for improved outcomes.
  • Case management, drug utilization and cost sharing are the top three priorities for managing specialty pharmacy benefits – all three are essential to managing costs and patient outcomes.
  • The employer-driven survey was conducted by MBGH, with guidance from Randy Vogenberg , PhD, principal at the Institute for Integrated Healthcare. The objectives were to identify and assess the level of knowledge and benefit design gaps of employers in the area of specialty pharmacy drugs and biologic products used to treat conditions such as multiple sclerosis and arthritis. These drugs present significant cost challenges to employers, as well as logistical issues for patients, physicians, pharmacies and manufacturers, as these drugs often require special approvals for their use, instructions on dosing and side effects, and appropriate storage and distribution.

    Survey respondents
    Approximately 70 employers responded to the online survey. The top industries represented were manufacturing (34 percent), government (16 percent) and education (13 percent); 87 percent were self-insured and 13 percent fully-insured. Thirty-two percent have an active population of 1,001-5,000, while 26 p
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    SOURCE Midwest Business Group on Health
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