Results of biologics and specialty pharmacy research confirm knowledge gap

August 19, 2011

How much do employers know regarding biologics and specialty pharmacy?

How much do employers know regarding biologics and specialty pharmacy? A recent survey indicates that while approximately half of employers had a moderate understanding related to biologics and specialty pharmacy, about one-third did not know how much their claim costs had increased over the last few years.

The Midwest Business Group on Health (MBGH), in partnership with Randy Vogenberg, PhD, principal at the Institute for Integrated Healthcare in Sharon, Mass., will present the initial year results of a employer-driven research and demonstration project that aims to identify and address knowledge and benefit design gaps of employer plan sponsors and other key stakeholders in the area of biologics and specialty pharmacy, during the Pharmacy Benefits Academy event in Chicago on August 24th.

Attendee feedback will be collected and incorporated into a revised survey that will be fielded early 2012 to reevaluate the results toward closing identified gaps. A second presentation will be done on October 6th with the Mid Atlantic Business Group on Health.

About 120 employers from around the country ranging in size from 500 to 25,000 employees responded to the original survey, according to Vogenberg, who is also executive director of the Biologic Access & Finance program at The Jefferson School of Population Health in Philadelphia. An early sample analysis done with MBGH showed that approximately half of employers had a moderate understanding related to biologics and specialty pharmacy; however about one third did not know how much their claim costs had increased over the last few years.

“It’s very different than what most of us who are in this business think about it,” Vogenberg told Formulary. “There are real gaps in the level of understanding and knowledge about this area of medical as well as pharmacy benefits.”

As the data is refined with feedback from the pilot programs and the advisory council, the group will be developing an employer-focused toolkit that can assist employer decision-makers with the complexities inherent in biologics coverage, and help to address the issue of how employers can effectively manage this aspect of their healthcare benefit.

“We’re really trying to look at this as taking a step back and making sure that we have a good baseline for understanding what employers know and understand in this area then we’ll move forward from there to identify what other tools or what other information would be important; what types of benchmarking could be of value to them,” he said.

“I think if we can really understand the commercial market better, it would really help everybody with a stake in paying for benefits, including CMS,” he added.

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