Employer Perspectives Specialty Drug Step-Therapy Program Evaluation
American Health and Drug Benefits, September 2016 Vol 9, No 6 – Industry Trends
Matthew Harman, PharmD, MPH, Director, Clinical Pharmacy Strategies Employers Health, Columbus, OH
F. Randy Vogenberg, PhD, RPh, Strategic Advisor and Co–Project Leader, Midwest Business Group on Health National Employer Biologics & Specialty Drug Initiative
Chicago, IL, Partner, Access Market Intelligence, Greenville, SC
Self-funded plan sponsors of commercial insurance health plans include employers, municipality governments, and unions. In many areas, a coalition of plan sponsors work together in partnership to purchase and/or manage healthcare benefits, such as prescription drugs, as a benefit carve-out from their medical benefits. With more than 300 private and public members of Employers Health of all sizes and industry types spread across 31 states, Employers Health is one such coalition that brings value to its employer members through a host of strategic solutions that help them realize the best-in-class strategies, maximize these strategies through collective purchasing, advance the strategies through the use of data analytics, and accelerate strategic results through the use of technology.
Participating in the National Employer Initiative on Biologic & Specialty Drugs (NEIBSD) effort to develop pilot demonstration projects for change in managing benefits for specialty drugs, Employers Health identified a couple of options for their drug purchasing coalition population. In early 2014, Employers Health decided that an evaluation of the effect of an employer-based step-therapy program for rheumatoid arthritis (RA) and multiple sclerosis (MS) on pharmacy and medical costs for select specialty drugs would be a good starting point for this pilot research effort.
A total of 3 different employers participated in this aggregate study. Their combined, deidentified claims data yielded the following results for RA and MS therapies.
Decisions regarding benefit design and tactical tools, such as step therapy, have been a focus of interest for several years among the health plan sponsors. Performing real-world assessments of what does and does not work, or what is of limited value to employer plan goals, is important for plan sponsors.