Employers may be starting to get the hang of specialty pharmacy. In the latest survey from the Midwest Business Group on Health, 49% of responding companies say they have an above average understanding of the benefit; in 2011, 78% claimed a low to moderate understanding.
MBGH, with guidance from Randy Vogenbuerg, PhD questioned approximately 70 employers with populations between 1,001 and 15,000 about knowledge and benefit design regarding specialty pharmacy drugs and biologic products used to treat conditions such as multiple sclerosis and arthritis. These drugs present unique logistical issues, as well as significant cost challenges.
Thirty-five percent of respondents are experiencing cost increases of 11% to 30% in the past three years, and 10% are experiencing 31% to 50% cost increases. A full quarter don’t know what their cost increases have been.
Another 35% of those surveyed are using traditional pharmacy design of tiers, coinsurance and/or copays, while only 21% use special tiers, underscoring, MBGH finds, the need for benefit design innovation.
“With costs estimated to make up 40% of an employer’s total pharmacy spend by 2020, it’s essential that they focus their attention on managing this benefit — doing nothing is no longer an option,” says Cheryl Larson, MBGH vice president. “Since employers primarily fund health care benefits for employees, their understanding of specialty drugs and related costs will be a key factor in resolving current challenges.”
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