The Five Rights framework targets critical issues and opportunities for specialty stakeholders including manufacturers, providers, health plans, and pharmacy benefit managers. The framework outlines key areas for each stakeholder to improve and was developed to raise purchaser expectations for industry stakeholders to help them better understand, evaluate and improve the specialty drug marketplace.
“Specialty drugs are the fastest growing area of spend for employers today,” said Mike Thompson, National Alliance president and CEO. “While these new drugs are truly innovative and important, the specialty drug marketplace itself is dysfunctional with high cost, high variation and high waste. We need to collaborate with stakeholders to wring out the costs of poor quality and unwarranted cost, complexity and conflicts.”
The framework was developed as a collaborative effort of the National Alliance and several purchaser-led member coalitions including the Minnesota Health Action Group, Midwest Business Group on Health and the Florida Health Care Coalition. The information is being shared with purchaser coalitions across the country.
“After two years of intensive study, Action Group members developed this framework to offer a common ground for all stakeholders,” said Carolyn Pare, president and CEO for the Minnesota Health Action Group, developer of the initial Five Rights. “Offering a road map for the Right Drug, Right Price, Right Place, Right Support and Right Data, this framework provides insights for each stakeholder to do their part to deliver on that promise.”
Cheryl Larson, vice president for the Midwest Business Group on Health, a coalition that developed and is leading a national employer specialty drug initiative added, “Vendor contracting should be based on full transparency and accountability to eliminate waste, reduce the impact of middlemen, mitigate costs and lead to overall improved plan performance and member health. We’ve established these rules of engagement to assist employers in raising the bar.”
Highlights of The Five Rights framework includes
- Base practices and decisions on clinical efficacy and safety independent of conflicted interests.
- Cover testing that supports improved assessment of correct drug, dose, 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.
- Align value based contracting with performance and adherence to high value drugs with correct dose and duration consistent with guidelines.
- Require cost parity or benefits differentials across sites of care for same drugs and services.
- Support patients on drug administration and needed emotional and social support to increase adherence and improve outcomes.
- Discontinue consumer coupon programs that encourage use of low-value, high-cost drugs in place of therapeutically equivalent.
“As purchasers and purchaser coalitions, we play a critical role to help rationalize the specialty drug marketplace,” said Karen van Caulil, president and CEO of the Florida Health Care Coalition and National Alliance board chair. “When we act together and are open to disruptive innovation, we can change the system for the better.”
Additional details can be found on the National Alliance website.
About National Alliance of Healthcare Purchaser Coalitions The National Alliance is a nonprofit network of business health coalitions, representing more than 12,000 purchasers and 41 million Americans. The National Alliance through its coalitions are dedicated to driving innovation, health, and value through the collective action of public and private purchasers. The organization seeks to accelerate the nation’s progress toward safe, efficient, high-quality healthcare and the improved health status of the American population. To learn more, visit nationalalliancehealth.org or connect with us on Twitter