|Nationally recognized resource addresses the "5 Rights;" provides 20 actionable goals for health plans, providers, pharmacy benefit managers, specialty pharmacies, and drug companies
BLOOMINGTON, MN (February 7, 2019) - Imagine paying $1,000 for a single pill or dose of medication that you need to treat a life-threatening condition, or over $400,000 a year to manage a chronic condition. That's well over the median household income in the United States. And while only 1 to 2 percent of Americans fall into this category, they accounted for approximately 38 percent of total retail drug spend (drugs dispensed through pharmacies) and 60 percent of non-retail drug spend (drugs administered by health care providers) in 2017. Recognizing the complexity of the specialty drug marketplace and how difficult it is for employers and patients to get information about how the supply chain works or to make sure they're getting the best value for their money, the Minnesota Health Action Group has released a Specialty Drug Employer Playbook that is now available online.
The Playbook is the result of a four-year effort that included a two-year Specialty Pharmacy Learning Network and a two-year, multi-stakeholder Guiding Coalition. The cumulative effort was launched and managed by The Action Group in an effort to convene health care stakeholders and industry experts to learn about what drives drug costs and to identify solutions.
The Guiding Coalition is composed of 40 individuals, employers and industry experts representing different perspectives and roles, including health plans, providers, pharmacy benefits managers, specialty pharmacies, and drug manufacturers. Over the course of 2,000 hours and 20 months, this collective group drilled into the factors that influence price transparency; costs that are paid by health plans, employers, and consumers; and the ability for purchasers to get the best value and developed a list of steps stakeholders can take to advance the "5 Rights" - right drug, right price, right place, right support, and right data.
"Inaction is not an option," said Carolyn Pare, president and CEO of the Minnesota Health Action Group. "For years, employers and consumers have been paying for things we don't even know we're paying for. This has to change. With the Playbook, employers will now be better equipped to gain more control over specialty drug use and spend on behalf of their employees, which will ultimately contribute to stabilizing a very broken system."
Pharmaceutical costs have plagued the health care industry and caused patients to take unwanted measures as prices have become untenable for many. People who take specialty drugs for conditions like multiple sclerosis or cancer are hit especially hard by these increases. According to a PwC Health Research Institute report, spending on specialty drugs is expected to increase 361 percent from 2012 to 2020. Unfortunately, this increased cost doesn't always translate to increased value for patients or employers.
"Price is not the only issue, but it's always an important issue when talking about value," said Stephen Schondelmeyer, Pharm.D., Ph.D., professor and director, PRIME Institute at the University of Minnesota. "Individuals and organizations who pay the cost of prescription drugs need to know what they're paying for and how much in order to manage the cost and compare it to the value. For employers, that means having access to individual claims data at all levels."
Through its work with national and world-class pharmaceutical experts like Schondelmeyer, the Action Group Guiding Coalition discovered that the specialty drug market is riddled with middlemen and true visibility into pricing and value is nearly impossible, and for employers, accessing data about drug claims is not as easy as it sounds. To address this, the Playbook outlines systemic actions that can be taken and provides guidance on:
"Transparency means different things to different people. And ultimately, we need to push beyond transparency to solutions that ensure employers and individual purchasers have access to the right drug, at the right price, at the right time, in the right setting, and that they have access to the right data, " said Pare.
- Entities that are involved in the pricing and distribution of specialty drugs;
- How to work with providers, health plans, and PBMs;
- What employers should expect from these partners;
- Questions to ask to ensure employers get the data they need to make informed decisions about prescription drug benefits;
- What the true impact of rebates and coupons is; and
- How to better understand their fiduciary responsibility.
To view the full Specialty Drug Employer Playbook, visit http://mnhealthactiongroup.org/wp-content/uploads/2018/12/BKLT_MNHealthActionGroup_112118-2.pdf.
Follow on social: @ActionGroupMN, #SpecialtyRx, and #AGCommunityDialogue.
About the Minnesota Health Action Group
The Minnesota Health Action Group is a coalition of public and private purchasers whose sole purpose is to represent the collective voice of those who write the checks for health care in Minnesota. Action Group members collaborate with community stakeholders to drive innovations that support high-quality health care, create engaged consumers, and ensure the economic vitality of all Minnesota communities. Based in Bloomington, MN, the Minnesota Health Action Group was formed in 1988 as the Buyers Health Care Action Group. To learn more, visit www.mnhealthactiongroup.org. Follow on YouTube, LinkedIn and Twitter.