Pharmacy & Medical Drugs

Pharmacy & Medical Drugs Initiative

To drive collaboration to obtain better value and support all healthcare stakeholders to align key efforts, the National Alliance is addressing a number of topics affecting the pharmacy and medical side of benefits includes contracting and formulary management, reducing waste, pharmacy benefit manager (PBM) performance, pricing inequity, personalized medicine, and value-based benefit design.

The key priorities for this initiative include developing a relevant value prop for employers on drug efficacy and safety; expanding purchaser engagement and knowledge of best practice strategies; formulary management and reduction of waste; the impact of hospital pricing practices; value-based contracting to align performance and adherence; sites of care; and evaluation of conflicting practices across the system.

Guidelines and an engagement framework, The Five Rights Framework, targets critical issues and opportunities for healthcare stakeholders including manufacturers, providers, health plans, and PBMs.

Our Next Steps

Guidelines have been integrated into our 2018 PBM Assessment, along with a new set of key principles for examining an influential drug policy from a purchaser perspective. Looking forward, we will assess our current activities and determine recommendations for employers and other key stakeholders that will address drug pricing, support better drug management care delivery.

Featured Resources

Employer Playbook on Biosimilars

This playbook provides clear information to inform conversations with health plans and other vendor partners.

Improving Drug Management

This report offers insights on how employers can better understand the landscape biosimilars. 

Action Brief - Accelerating Action

Employer Rx Value Report

This report offers insights on how employers can better influence how drugs are being managed on their behalf including the current value frameworks that shape decision-making across the system.

Featured Coalitions in Action

The Kansas Business Group on Health has partnered with the Pittsburgh Business Group on Health to offer the Right Rx program to members. Right Rx is a therapeutic equivalent program that identifies lower-cost options of medications that employees are currently taking, then contacts the employee’s provider on their behalf to suggest alternative medications. Learn more.
Business Health Care GroupThe Business Health Care Group (BHCG) is focused on offering a variety of employer solutions from best-in-class strategic partners. Among these partners is Navitus Health Solutions, a transformative pharmacy benefit manager using a business model based on complete transparency and lowest net cost. As a full pass-through pharmacy benefit solution, Navitus gives clients 100% of all rebates and any other revenue. Access to Navitus via BHCG membership is available to employers nationwide. Learn more.

Our Value Agenda:

Uniting and raising our voices together

  • Adhere to key drug purchaser policy principles including full transparency, defined value, no conflicts of interest, competitive market dynamics, and pricing equity
  • Respect the need for diverse solutions based on local and regional needs
  • Use the results gathered through the eValue8™ Deep Dive Module on the medical side of drug benefits to drive market improvements
  • Develop a sustainable process for purchaser engagement on drug management
  • Convene and collaborate with diverse stakeholders to ensure they are measuring progress and achieving goals
  • Contribute to bringing order to a dysfunctional marketplace that is subject to high cost, high variability, and high waste
“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.”
Cheryl Larson, President and CEO, Midwest Business Group on Health