Beyond the Cost of Biologics: Employer Survey Reveals Gap in Understanding Role of Specialty Pharmacy and Benefit Design

Vogenberg, F. Randy; Larson, Cheryl; Rehayem, Margaret; Boress, Larry
January 2012
American Health & Drug Benefits;Jan/Feb2012, Vol. 5 Issue 1, p23
Academic Journal
Background: Advances in biotechnology have led to the development of many new medical therapies for a variety of diseases. These agents, known as biologics or specialty drugs, represent the fastest-growing segment of pharmaceuticals. They have often proved effective in cases where conventional medications have failed; however, they can cost up to $350,000 per patient annually. Employers sponsor a significant proportion of plans that provide healthcare benefits, but surveys on benefit coverage have neglected to measure employers' understanding of these drugs or their use. Objective: To establish a baseline understanding of specialty pharmacy drug benefit coverage from the perspective of the employer (ie, commercial benefit plan sponsors). Methods: The Midwest Business Group on Health (MBGH), a Chicago-based, nonprofit coalition of more than 100 large employers, in collaboration with the Institute for Integrated Healthcare, conducted a national web-based survey to determine the extent of employer understanding of specialty pharmacy drug management. MBGH, along with 15 business coalitions nationwide, distributed the survey to their employer members. A total of 120 employers, representing more than 1 million employee lives, completed the survey online. The results were then analyzed by MBGH. Results: Of the 120 employers surveyed, 25% had "little to no understanding" of biologics, and only 53% claimed a "moderate understanding" of these agents. When asked to rank the effectiveness of biologics-related disease management support for their employees, 45% of the participating employers did not know whether productivity had increased, and 43% did not know whether their employees had experienced increased quality of life as a result of taking these drugs. The majority (76%) of employers continued to rely heavily on print medium to communicate with their covered population. Overall, the vast majority of employers (78%) claimed either "little to no understanding" or a "moderate understanding" of specialty pharmacy. Conclusions: That the majority of employers admit they do not understand specialty pharmacy indicates that efforts are needed to fill in this knowledge gap to enable employers to design useful or appropriate drug benefit programs and manage them more effectively to control costs and optimize their employees' healthcare outcomes. Efforts to educate employers will require continued evaluation to ensure an effective communication between them and their employees while this area of medicine continues to grow.


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