Transcript Slide 1

Midwest Business Group on Health
National Employer Survey on
Biologics/Specialty Pharmacy
August 2011
MBGH Biologics/Specialty Pharmacy Initiative
Establishing an Employer View
• MBGH sees significant growth in specialty pharmacy products
and related cost impacts to employers
• MBGH Board cites Biologic/Specialty Pharmacy #1 priority for
2010 and 2011
• MBGH partners with Dr. Randy Vogenberg in developing a
research project to help employers:
– Understand what Biologics/Specialty Pharmacy is and the
challenges they must prepare for
– More effectively manage benefit through plan design innovation
and partnering with specialty vendors in contracting and patient
management
– Understand the importance of managing their at-risk population
and communicating specialty benefits to employees
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MBGH Biologics/Specialty Pharmacy Initiative
Addressing Employer Needs
• Phase I - 2011
– Employer Advisory Councils – Chicago & Baltimore
– National Employer Baseline Survey
– National Vendor Survey
– Employer Toolkit and Educational Outreach with employer group
testing in two markets
• Phase II - 2012
– Review pilot efforts and expand outreach and dissemination of
findings
– Expand survey research, updates to toolkit and national educational
outreach
– Re-evaluate work and external reporting on results
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Survey Demographics – July 2011
• MBGH partners with 15
NBCH sister coalitions
• 120 national employers
participate in survey
– Representing more than 1
million employee lives
• Average Age:
– 47% of employees are
41 to 45 years of age
• 36% of survey respondents
are manufacturers
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• Average employer size:
– 22% - Less than 500 ees
– 17% split - Over 25000 and
1000 to 3000 ees
• Employer funding of health
benefits
– 69% - Self-insured
– 19% - Fully-insured
– 13% - Combo of benefits
• Employers who offer
combination of benefits
– 60% - don’t combine
– 12% - FF 10%; SF 90%
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Size of active employee population in U.S.
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Funding of health benefits/employer size
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Level of understanding of specialty pharmacy
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Level of understanding/employer size
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Total medical and pharmacy spend 2010
Per employee spend 2010
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Special meds paid through medical plan
Specialty meds paid through pharmacy benefits
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Increase of specialty total claims over
past 3-5 years
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Highest cost specialty medications
Highest cost drugs
1.
2.
3.
4.
Vaccine (not childhood)
Arthritis
Cancer
Multiple Sclerosis
• Employee out of pocket or
co-insurance per Rx
– Average Minimum - $10 to
$20
– Average Maximum - over
$200
Patient Mgmt Services
• 72% - Case Management
• 69% - Disease Management
• 68% - Drug Utilization
Management
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• 54% of employers require that
employees use the Specialty
Pharmacy to receive coverage
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Of the 54% of employers who require use of
the specialty pharmacy…….
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Specialty pharmacy plan design
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Incentives offered for use of specialty pharmacy
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Benefits and service providers utilized for
specialty pharmacy
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Entities who support employer in management,
contracting and benefit design
Management
Contracting
Benefit Design
Do on own or
In-house
36%
51%
79%
Benefits Consultant
21%
60%
77%
Outside Pharmacy
Consultant
28%
44%
74%
PBM
61%
41%
70%
Specialty Pharmacy
56%
29%
54%
Health Plan
46%
42%
76%
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Level of importance for key areas when
contracting with specialty pharmacy
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Use of other options for specialty pharmacy
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Importance of medication-related cost
transparency in vendor contracts
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Entities who support employer in
case and disease management
Case
Management
Disease
Management
Do on own or
In-house
20%
23%
5%
70%
Health Plan
78%
64%
4%
12%
PBM
47%
39%
11%
35%
Specialty Pharmacy
48%
34%
10%
37%
Outside Vendor
18%
26%
8%
64%
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Don’t Know NA
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Effectiveness of case and disease mgmt
support with covered population
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Effectiveness of initiatives to increase
employee awareness
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Communication tactics for covered population
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Effectiveness of strategies and employee
communication efforts over the past 3-5 years
Very
Effective
Effective
Somewhat
Effective
Not
Effective
4%
Don’t
Know
Generic Options
22%
32%
12%
31%
Protocols used for prior approval
20%
24%
22%
Cost share incentive
11%
20%
22%
10%
38%
Days supply-limited messaging
10%
27%
25%
4%
34%
Communication from pharmacist
10%
17%
22%
3%
48%
Integrated pharmacy network
10%
21%
18%
3%
49%
Inclusion/exclusion criteria
9%
17%
22%
4%
47%
Communication from physician
8%
14%
21%
3%
55%
HRA
5%
16%
26%
16%
36%
Formulary explanation
5%
24%
32%
7%
31%
Cost comparison
5%
15%
29%
9%
41%
Audience benefit management
communications for employees
Utilization management mailing and phone
messages
3%
22%
22%
4%
49%
3%
18%
28%
9%
42%
34%
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Importance of tactics used in managing
specialty medication costs
Very
Important
Important
Somewhat
Important
Not
Important
Don’t
Know
Improved contracting terms, coverage for
claim reimbursement
29%
25%
11%
1%
33%
Incorporation of wellness/catastrophic care
coordination strategies
28%
22%
9%
5%
36%
Improved coordinated info on therapies
27%
27%
12%
1%
32%
Contractual opportunities – i.e. rebates
25%
26%
16%
4%
29%
Innovative plan designs for coverage
22%
41%
9%
3%
27%
Vendor provides analysis or cost modeling
20%
28%
11%
8%
34%
Alternative drug delivery channels for
access/distribution
17%
30%
14%
2%
37%
Risk sharing contracts for Rx use
12%
15%
17%
4%
52%
Direct manufacturer contracting
12%
23%
16%
10%
38%
Exclusive networks by setting of care
9%
23%
15%
4%
49%
Alternative risk financing-actuarial designed
coverage
9%
29%
19%
3%
40%
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Contacts
Cheryl Larson, Vice President
Midwest Business Group on Health
[email protected]
Cary Conway
MBGH Public Relations
[email protected]
MBGH is one of the nation's leading not-for-profit business coalitions of private and
public employers. Members are represented by human resources/health benefits
professions for approximately 110 large self-insured public and private employers, who
represent over 3 million lives and spend more than $3 billion on health care benefits
annually.
F. Randy Vogenberg, PhD, Principal
Institute for Integrated Healthcare, Sharon, MA
Strategic Pharmacy Advisor, Business Group Pharmacy Collaborative
& Senior Fellow, Jefferson School Population Health
[email protected]
The Institute for Integrated Healthcare, an organization that provides integrated
pharmaceutical benefits consulting and education to self-insured employers and
business coalitions.
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