Project Activities

Project Activities

The National Employer Initiative on Specialty Drugs project was launched to bring forth real world knowledge, research and benchmarking to support employers in:

  • Understanding what biologics and specialty drugs are and how they can manage costs more effectively.
  • Implementing innovative benefit coverage approaches focused on total cost of care and patient outcomes.
  • Identifying and addressing specialty drug use in the medical and pharmacy benefit.
  • Optimizing PBM contracts to address transparency, pricing and rebates.
  • Developing more effective partnerships with pharmacy benefit stakeholders.
  • Gaining knowledge, guidance and access to no-cost resources to support plan performance.
  • Removing inappropriate waste from PBM and health plan contracts related to specialty drugs.

Key project elements include:

  • Employer Advisory Council consisting of representatives from large self-insured employers.
  • Annual Employer Benchmarking Surveys
  • National Educational Outreach – programs on specialty drug management have been presented across the country.
  • Employer Coalition Collaboration – sharing employer-driven research from and open collaboration with sister coalitions of the National Alliance of Health Care Purchaser Coalitions (formerly National Business Coalition on Health).
    • Employers Health Coalition – Arkansas
    • Employers Health Coalition – Ohio
    • Florida Health Care Coalition – Florida
    • HealthCare 21 Business Coalition – Tennessee
    • Mid-America Coalition on Health Care – Kansas
    • Midwest Business Group on Health – Midwest
  • Employer Toolkit – providing access to no-cost resources, tools and other valuable information to support employer understanding and management of specialty drugs.
  • Multi-Stakeholder Collaboration – Annual invitation-only meeting with employers, employer coalitions, PBMs, specialty pharmacies, health plans, pharmaceutical manufacturers and other market stakeholders to support project direction and key activities. The Multi-Stakeholder Council has identified and is working on the following issues: 
    • Offering effective education to address the overall lack of industry knowledge on drug pricing, comparative effectiveness research and the related value of specialty drugs.
    • Driving middleman/PBM transparency and accountability for pricing, contracting and rebates to support informed employer decision-making.
    • Redefining quality based, economically driven and outcomes-based narrow networks – Centers of Excellence and High-Performing Networks – to ensure optimal plan performance from the employer perspective.
    • Determining the use and value of co-pay/coupon assistance and other financial assistance programs that could have significant unintended consequences to plan members as well as plan sponsors in the post-ACA market.
    • Integrating performance and outcomes-based guarantees into direct provider, middleman, PBM and vendor contracts.
    • Ensuring vendors provide actionable data and real time reporting for the plan sponsor and member.
    • Identifying value-based tools that integrate treatment guidelines to effectively address affordability and efficacy as part of the plan design strategy.
    • Promoting available resources, including this toolkit, NCCN’s Cancer Resource Guide and sister coalition resources. 

Project activities include:

  • Developing and refining existing resources and tools from the employer perspective to support management of specialty drugs.
  • Strategy and White Paper on the Impact of the Middleman on Medical & Pharmacy Costs to Self-Funded Employer Plan Sponsors.
  • Directional support and/or guidance for data mapping from an employer perspective.