Featured Health Business Daily Story, Sept. 18, 2017

Employers Cite Specialty Pharmacy, Coupons, Opioids as Top Concerns (with Chart: 2018 Specialty Pharmacy Benefit Management Techniques)

Reprinted from DRUG BENEFIT NEWS, biweekly news and proven cost management strategies for health plans, PBMs, pharma companies and employers. Subscribe today!

By Angela Maas, Managing Editor
August 25, 2017Volume 18Issue 16

Employers are projecting a 5% increase in the total cost of providing medical and pharmacy benefits in 2018, according to the National Business Group on Health (NBGH). That would make it the fifth consecutive year that health care costs rose 5% after plan design changes were implemented.

For its 2018 Large Employers’ Health Care Strategy and Plan Design Survey, released Aug. 8, NBGH polled 148 of its members in May and June. Respondents employ about 10 million employees and provide health insurance to about 15 million employees and their dependents.

The survey also found that “for the second year in a row, specialty pharmacy is the top driver of health care costs,” according to the group’s president and CEO, Brian Marcotte, speaking at an Aug. 8 press conference in Washington, D.C. “Managing these high-cost drugs” is a top priority, and that extends to where they are administered, he said, noting NBGH members have seen as much as a sevenfold difference in costs depending on the site of administration. From 2017 to 2018, the percentage of respondents saying they use site-of-care management jumped from 30% to 44% (see chart, below.)

Drug Benefit News

The top management strategy for specialty drugs is implementing more aggressive utilization management protocols, down slightly in 2018 to 71% from 74% in 2017, and requiring that these drugs be obtained through either a specialty pharmacy or a PBM’s specialty unit, also down slightly year over year from 69% to 68%.

Employers also said they have pharmacy benefit concerns beyond specialty drugs, and they are putting in place programs to deal with those issues. Copayment coupons were one such area, with 57% of respondents saying they were either concerned or very concerned about them. One-third of respondents said they have programs in place to make sure the value of a manufacturer coupon for a non-specialty drug is not applied to an employee’s deductible or out-of-pocket maximum. Opioid abuse is another big employer concern, with 80% saying they are concerned or very concerned about it. Respondents reported several strategies they have implemented with their health plans and PBMs to address this.

Visit www.businessgrouphealth.org.

2018 Specialty Pharmacy Benefit Management Techniques

Q: For 2018, which additional methods will you use to manage specialty pharmaceuticals?


SOURCE: National Business Group on Health, 2018 Large Employers’ Health Care Strategy and Plan Design Survey, released Aug. 8, 2017. Visit www.businessgrouphealth.org.

This story was reprinted from DBN sister publication Specialty Pharmacy News. For more information or to order, visit https://aishealth.com/marketplace/specialty-pharmacy-news.

Copyright © 2017 Managed Markets Insight & Technology, LLC. All Rights Reserved.

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