Medical and Pharmacy Drug Management

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.

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.

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.

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 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.

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.

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.

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.

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.

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.

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.

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.

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.