Medical and Pharmacy Drug Management
Overview
The National Alliance is addressing topics affecting the pharmacy and medical side of benefits, especially the high cost of prescription drugs with the goal of driving better transparency and value on behalf of employers/purchasers.
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Pharmacy and Medical Drugs
Defining and Driving Value
The National Alliance works with policymakers, employers/purchasers, and other stakeholders across the pharmacy and medical drug supply chain to influence competition, transparency and value. Current issues of focus include pharmacy benefit manager (PBM) performance, contracting and formulary management, biosimilars, reducing waste, pharmacogenomics, and value-based benefit design.
The initiatives focus on practices affecting both pharmacy and medical benefits, with a strong emphasis on the rising costs of healthcare, hospital pricing, and prescription drugs. For example, the National Alliance has recently been engaging with policymakers to provide insights on the 340B program, its impact on escalating healthcare expenses for working families and employers, and potential areas for reform.
Explore these additional resources for a deeper look at the 340B program’s impact on healthcare costs and reform initiatives.
Medical and Pharmacy Drug Management Resources
The National Alliance supports policies to reduce prescription drug costs for all purchasers while encouraging meaningful innovation. These resources support employers/purchasers in injecting greater competition, transparency and value into pharmacy and medical drug management.
Case Studies: Coalitions and Employers are Disrupting the PBM Misalignment Status Quo
The National Alliance is continuously exploring how misalignment between employer needs and PBM service provider value propositions have affected employers and other and plan sponsors. As part of this exploration, we conducted interviews with employers and coalitions nationwide to provide thought starters and inspiration for organizations that are exploring alternatives to current PBM vendors.
Pharmacy Benefit Management Misalignment: Vendor Engagement Template
As the pharmacy benefit management industry undergoes the most significant transformation in decades, employers are at the forefront of driving change. This vendor engagement template equips them with information to assist in evaluating and comparing PBM proposals.
Employers Beware: Alternative Funding Programs Require Careful Review to Avoid Negative Consequences
As healthcare costs increase, employers/purchasers continue to explore strategies to better manage pharmaceutical costs. One approach is the use of alternative funding programs, which are fraught with unintended consequences. “If it sounds too good to be true, it might be.
Time to Act: Understanding PBM Practices Enables Employers to Ignite Change
For the past three decades, the management of pharmacy benefits has become increasingly opaque, convoluted and misaligned. Rather than improving drug value and creating an efficient marketplace, the industry has fueled a flawed contracting model and unprecedented market consolidation. It’s time for employers to take the wheel.
Employer Playbook on Biosimilars
Employer and other healthcare purchasers grapple with how best to integrate biologics into health and pharmacy benefit plans. The National Alliance has developed this playbook to provide clear information to inform conversations with health plans and other vendor partners.
Prescription Digital Therapeutics (PDTs)
This PDT playbook for employers offers an overview of the digital health space, recommendations for evaluating and implementing a PDT strategy, and insight into the employer role in promoting PDTs.
Addressing Pharmacy Benefit Management Misalignment
High prescription drug costs continue to bankrupt families, put financial strain on businesses, and drag down the US economy and pharmacy benefit management plays a significant behind-the-scenes role. To arm employers and other plan sponsors with a blueprint to understand and navigate PBM relationships and strengthen their negotiating and contracting capabilities, the National Alliance has developed this playbook for purchasers.
Employers’ Prescription for Affordable Drugs (EmployersRx)
EmployersRx supports policies that would require PBMs to make pricing data available to payers and compel drug companies to report and justify price increases for some medications. This coalition also seeks to strengthen competition and remove barriers that stifle the development and use of generic drugs and biosimilars.
Prescription Drug Provisions in the Inflation Reduction Act of 2022
This Health Policy in Transit is a high-level summary of the prescription drug provisions contained in the Inflation Reduction Act. It also describes the decision made by the Senate Parliamentarian to exclude commercial plans from the inflation rebate provision, and how this will potentially affect employer plan sponsors.
Improving Drug Management
Reduced barriers to biosimilar adoption could generate
savings of about $25 billion over 10 years, or roughly 0.5% of national spending on prescription drugs. However, other organizations indicate biosimilars savings could project upwards of $133 billion by 2025, but only if policymakers encourage greater biosimilar adoption. A summary of employer roundtables offers insights into overcoming biosimilar barriers.
Opportunities in Pharmacy Benefit Management
PBMs are under considerable scrutiny today, but the organizations in this white paper have demonstrated a willingness to open their actions to analysis. This guide helps employers/purchasers open discussions with current or prospective PBMs.
Findings on the State of the PBM Industry
This 2020 Report includes a cross-section of PBMs. For the first time, this report publicly identifies the participating PBMs’ comparisons in graph form. It also includes educational articles, ranging from opioid treatment to maximizing PBM audits, and understanding copay assistance programs.
Biosimilars in the Pharmacy Benefit
Despite the fact that less than 2% of the population uses biologic drugs, they account for 26% of national prescription drug spending. Biosimilars can expand options, improve affordability, and increase access to therapy.
Coalitions In Action
Membership in the National Alliance is a catalyst for state and regional coalitions and their employer/purchaser members to advance key initiatives. Together, they leverage their collective influence to drive health, equity and value.
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Business Health Care Group (Wisconsin)
The Business Health Care Group (BHCG) offers 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.
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Purchaser Business Group on Health
To reduce healthcare costs and improve access to higher quality care, PBGH helps purchasers disrupt the complicated and opaque pharmaceutical supply chain and hold vendors accountable. The result is transformative benefit design and access to better and more transparent drug pricing for employers and their employees.
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HealthCareTN (HCTN)
Pharmacy benefits continue to operate in a convoluted market, rife with disincentives, little to no transparency, and further complicated by consolidation. As specialty pharmacy continues to drive medical and pharmacy drug spend, employers are motivated to find alternatives to the status quo. HCTN introduces innovative strategies, practices and players with a goal of strengthening employer member understanding as they engage with the market.
Related News & Resources
- National Alliance In The News
- National Alliance In The News