Specialty Drug Marketplace

The Five Rights Framework

To drive collaboration to control cost, reduce waste and maximize effectiveness of specialty drugs, the National Alliance has developed stakeholder guidelines and an engagement framework targeting critical issues and opportunities for specialty stakeholders including manufacturers, providers, health plans, and pharmacy benefit managers.

  • Developed to raise purchaser expectations for what to expect out in the marketplace
  • Helps industry stakeholders better understand, evaluate and improve the specialty drug marketplace.  
  • Base practices and decisions on clinical efficacy and safety independent of conflicted interests/PBMs accept ERISA fiduciary status
  • Cover testing that supports improved assessment of correct drug, doses and duration of treatment for specific patient
  • Require purchaser transparency and engagement on key issues and National Drug Codes used by all providers, in all settings related to: prior authorization, utilization management, payment & rebates, claim level reporting, data analysis, provider contracts, patient outcomes, and quality improvement
  • Align value based contracting with performance and adherence to high value drugs with correct doses and duration consistent with guidelines
  • Require cost parity or benefit differentials across sites of care for same drugs and services
  • Support patients on drug administration and needed emotional/social support to increase adherence and improve outcomes
  • Discontinue conflicting practices such as low value coupon programs, drug price increases more than Consumer Price Index, and exclusion of high value delivery options.

 

Looking for more information? 

View 2017 Press Release 
Download the infographic here!


 

Raising the Stakes 

  • Specialty drugs are fastest growing area of spend for both private & public purchasers 
  • Some drug prices grow at 500% or more US buys more and pays more than any other country
    manufacturers

High Cost, High Variation, High Waste

  • Variation in management of formulary, specialty list, utilization, clinical, pipeline, etc.
  • Wide variation in price 2x-25x Up to 30% not filled, 50% not taken, 10% admissions due to poor adherence

Complexity, Middlemen, Conflicts

  • Employers are often left without the needed data and information to manage specialty drug use and cost 
  • Our "stewards" contribute to these issues by adding complexity and cost to an inefficient supply chain.