CHICAGO, Jan. 24, 2013 /PRNewswire / -- Forty-nine percent of employers said they have an above average understanding of specialty pharmacy according to the latest survey from the non-profit Midwest Business Group on Health (MBGH), one of the nation's leading business groups of employers. This is a significant increase over a similar 2011 survey where 78 percent claimed to have a low to moderate understanding of this challenging benefit.
"With costs estimated to make up 40 percent 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," said 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."
- Executive leadership's level of interest in understanding specialty pharmacy benefits was average to low for 53 percent of respondents – a sign that employers need to engage them in this conversation.
- Twenty-five percent don't know what their cost increases have been over the past three years – these are missed opportunities for better managing of the benefit.
- Thirty-five percent are experiencing cost increases of 11-30 percent, while ten percent are experiencing 31-50 percent cost increases – making it critical to focus on understanding the benefit and working closer with service providers.
- Thirty-six percent do not know their company paid medical costs specific to specialty pharmacy drugs and related services – this is indicative of the confusion surrounding what specialty benefit costs run through the medical versus the pharmacy plan.
- Managing costs is very important to 86 percent of respondents and reducing inappropriate utilization is very important to 72 percent – although costs are very important, patient management is key to long-term success.
- For current specialty pharmacy plan design 35 percent are using use traditional pharmacy design of tiers, co-insurance and/or co-pays. Only 21 percent use special tiers with co-pays and/or co-insurance – this underscores the need for benefit design innovation.
- The majority of employers are still not offering incentives for requirements such as using a specialty pharmacy, participating in case management or adhering to medications – a missed opportunity for improved outcomes.
- Case management, drug utilization and cost sharing are the top three priorities for managing specialty pharmacy benefits – all three are essential to managing costs and patient outcomes.