The Business Group Blog was created to share and discuss information about challenges and solutions to the health care benefits issues that large employers face today and tomorrow — such as controlling health care costs, reforming the health care delivery system, and engaging employees in their health and benefits — and will provide insight into national health policy issues. We hope you find this information useful and will consider subscribing to the blog and sharing any thoughts or ideas with us at firstname.lastname@example.org.
There are 9 item(s) tagged with the keyword "Rx".
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In recent years, major breakthrough cancer therapies have entered onto the oncology stage, namely actors in immunotherapy that have shown extraordinary promise. These new agents differ from conventional treatments in that they selectively target aspects of the immune system to optimize the innate response to invading cancer cells.
As a follow up to our release of “Policy Recommendations to Promote Sustainable, Affordable Pricing for Specialty Pharmaceuticals,” in which we focused on policy recommendations we think the government should examine, this blog post focuses on policies we think are ill-advised. These policies may include specialty drug price caps, out-of-pocket payment caps, limitations on utilization management tools and mandated disclosure of proprietary information.
The Business Group is pleased to roll out a Public Policy Issue Brief that offers public policy recommendations to create a more favorable environment for financial sustainability and affordability of specialty medications. At the outset, understanding the challenge is important. With specialty drug expenditures trending at an all-time high and all indicators pointing to sustained increases over time, employers are strategizing on how best to manage growing pharmacy expenditures for this subset of drugs.
President and CEO of National Business Group on Health, Brian Marcotte, has created a list of six things to watch in 2017. It will be a year of uncertainty, opportunity and change. Will ACA be repealed and replaced? Will the move to value-based payments lose momentum? What will be the fate of proposed health plan mergers? Will pharmacy pricing remain in the spotlight? Will consumer engagement remain a top concern for employers? What about the well-workforce?
Patient (or “copay”) assistance programs and coupons present a bit of a double-edged sword. While they help facilitate payment for certain drugs, they also complicate the payment process immensely. Both help patients ultimately gain access to expensive drugs that otherwise may not be affordable. However, the intention behind each approach differs considerably, as does the overall impact.
The director of the Centers for Disease Control and Prevention (CDC) declared an opioid “epidemic” in the U.S. in 2011, and concern about this issue continues to grow. Employees that misuse or abuse prescription opioids are more likely to miss work, incur higher health care costs, file disability claims, and get demoted or fired. Sadly, more people died from drug overdoses in 2014 than in any year on record, and more than 60% of these deaths involved an opioid.
Employers can take several steps to stem the misuse of these drugs and provide assistance to employees and dependents in need of assistance to treat pain and addiction.
Are you struggling with managing specialty pharmacy in plan design? Our new Specialty Pharmacy Management Checklist provides detailed tips for staying ahead of the curve – from utilization management to reporting and accountability to employee education.
Here are some tips from the checklist:
For the first time in 2010, the number of specialty drugs approved by the FDA surpassed that of traditional drugs, kick-starting a trend that we're continuing to see year after year. While only a small fraction (approx. 4%) of the patient population uses specialty medications, these costly drugs now account for 25% of total US drug spending and is the fastest growing cost in most employers' health benefits.
Compounding pharmacies lost a big stream of revenue in the last few years when large employers, working closely with their PBMs, implemented caps and exclusions on compounded medications to better manage costs. While these control measures addressed a significant portion of unnecessary compounding, there are new creative compounding billing practices that are slipping through the cracks.
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