Twenty-five percent of employers have little or no understanding of specialty pharmacy and 53% have only a moderate understanding of this challenging benefit according to a new survey released by the Midwest Business Group on Health. The vast majority of the 120 employers – ranging in size from 500 to 25,000 employees – that responded to this national survey indicated they did not know how much their company was spending on specialty pharmacy medications through their medical or pharmacy plans. Additionally, almost 30% indicated that they did not know how much their total specialty claim costs had increased in the past three to five years.
The survey identified the level of knowledge and benefit design gaps of employer plan sponsors in the area of specialty pharmacy medications and biologic products used to treat conditions such as multiple sclerosis and arthritis. These drugs present significant cost challenges to employers, as well as logistical issues for patients, physicians, pharmacies and manufacturers, as these medications often require special approvals for their use, instructions on dosing and side effects, and appropriate storage and distribution.
“In addition to the uncertainty and challenges that health reform and the economy are placing on employers, health plans and pharmacy benefit managers, the real driver of drug cost trend growth for employers lies in biologics and specialty pharmacy,” says Cheryl Larson, MBGH vice president. Seventy-six percent of employers don’t offer employees an incentive to ensure proper compliance to medication and adherence to treatment for use of biologic/specialty medications.
Most employers are still using a traditional benefit design, including tiered formularies, co-payments and coinsurance for specialty drugs instead of value-based benefit designs that may be more appropriate for biologic/specialty pharmacy medications.
Forty-two percent of employers reported using PBMs to manage their specialty benefit, with 22% using their health plan and 18% using a combination of both. Only 13% of employers are using a specialty pharmacy provider.
