Learn about reference pricing as a purchaser in response to the high and rising pharmaceutical sales and innovative strategies for managing specialty drugs.
How High Will They Go? Managing Rising Drug Prices in a Changing Healthcare E...CompleteRx
In 2016, spending on prescription drugs is expected to reach $500 billion. So, how high will they really go? That is a common question asked with drug prices as recent headlines have exploited drug pricing schemes and how the pharmaceutical industry is handling rising prices. This webinar discusses how hospitals and health systems can prepare for and manage rising drug costs, ensure patient care and positively impact the bottom line.
How High Will They Go? Managing Rising Drug Prices in a Changing Healthcare E...CompleteRx
In 2016, spending on prescription drugs is expected to reach $500 billion. So, how high will they really go? That is a common question asked with drug prices as recent headlines have exploited drug pricing schemes and how the pharmaceutical industry is handling rising prices. This webinar discusses how hospitals and health systems can prepare for and manage rising drug costs, ensure patient care and positively impact the bottom line.
White Paper: Best Practices for Medical Benefit Management (MBM)Tai Freligh
Biologic, biotechnology-based, rare disease, or high-cost pharmaceuticals — collectively known as specialty drugs — can be covered under the pharmacy benefit, the medical benefit, or both depending on the benefit design plan sponsors require of the third-party administrator (including the pharmacy benefit manager – PBM; administrative service organization – ASO; or any administrator of a medical or pharmacy benefit).
On average, up to 50% of specialty drugs today are covered under the medical benefit.
With the exception of a few key therapy areas, traditional tools used to manage specialty drugs under the medical benefit, such as prior authorizations and medical benefit carve-outs (i.e., “white-bagging”), have yielded limited value to plan sponsors.
This thought leadership analysis, with insights from recognized industry experts, will provide an overview of the challenges.
Download the complete white paper to get the rest of the report, including a summary of the key issues plan sponsors must address and insights into best practices through an innovative new approach, Medical Benefit Drug Management (MBM).
Link: http://www.PharMedQuest.com/White-Paper
The Rise of Value-Based Contracting for Biopharmaceuticals and Medical Techno...Nathan White, CPC
ICON Access, Commercialisation & Outcomes (ACC) - November 2017 Pricing & Market Access Briefing
AUTHORS:
Michael Pace
Senior Principal, Pricing and Market Access
Guy Sherwin
Lead Consultant, EU Pricing and Market Access
At a recent OHE Lunchtime seminar, Dr James Chambers of Tufts Medical School examined the role cost-effectiveness evidence plays in health care resource allocation in the US and the potential value of expanding that. Specifically for Medicare, Chambers discussed to what extent coverage decisions for medicines are consistent with cost-effectiveness evidence and what might be gained by explicitly including economic evidence in Medicare coverage policy--in terms both of aggregate health gains and cost-savings. His analysis also considered the challenges associated with incorporating cost-effectiveness evidence in coverage policy, including implications of the 2010 US health care reform legislation.
GetPersonalized! Pharma's perspective on the future, Claudia KarnbachSitra / Hyvinvointi
Pharma's perspective on the future, Claudia Karnbach, Head, Global Business Development and Licensing, Specialty Medicine, Bayer Healthcare Pharmaceuticals (USA, New York)
Slides from the presentation Patricia Danzon gave on affordability at the ISPOR Europe 2018 conference in Barcelona, Spain Slides from the presentation Patricia Danzon gave on affordability at the ISPOR Europe 2018 conference in Barcelona, Spain on November 12th.
Best Practices in Controlling Prescription Drug CostsPSG Consults
An insightful pharmacy benefit cost containment overview co-presented by Jeff Legg, PSG's Consulting Services VP and Labor Practice Leader, at the 2016 IFEBP Conference in Orlando.
Evolving Approaches to Measuring the Value of New Health Technologies in the USOffice of Health Economics
At this OHE Lunchtime Seminar, Dr Steven Pearson of the ICER organisation in the US discussed current US approaches to defining "value," compared these to NICE and discussed what changes may occur in the future.
White Paper: Best Practices for Medical Benefit Management (MBM)Tai Freligh
Biologic, biotechnology-based, rare disease, or high-cost pharmaceuticals — collectively known as specialty drugs — can be covered under the pharmacy benefit, the medical benefit, or both depending on the benefit design plan sponsors require of the third-party administrator (including the pharmacy benefit manager – PBM; administrative service organization – ASO; or any administrator of a medical or pharmacy benefit).
On average, up to 50% of specialty drugs today are covered under the medical benefit.
With the exception of a few key therapy areas, traditional tools used to manage specialty drugs under the medical benefit, such as prior authorizations and medical benefit carve-outs (i.e., “white-bagging”), have yielded limited value to plan sponsors.
This thought leadership analysis, with insights from recognized industry experts, will provide an overview of the challenges.
Download the complete white paper to get the rest of the report, including a summary of the key issues plan sponsors must address and insights into best practices through an innovative new approach, Medical Benefit Drug Management (MBM).
Link: http://www.PharMedQuest.com/White-Paper
The Rise of Value-Based Contracting for Biopharmaceuticals and Medical Techno...Nathan White, CPC
ICON Access, Commercialisation & Outcomes (ACC) - November 2017 Pricing & Market Access Briefing
AUTHORS:
Michael Pace
Senior Principal, Pricing and Market Access
Guy Sherwin
Lead Consultant, EU Pricing and Market Access
At a recent OHE Lunchtime seminar, Dr James Chambers of Tufts Medical School examined the role cost-effectiveness evidence plays in health care resource allocation in the US and the potential value of expanding that. Specifically for Medicare, Chambers discussed to what extent coverage decisions for medicines are consistent with cost-effectiveness evidence and what might be gained by explicitly including economic evidence in Medicare coverage policy--in terms both of aggregate health gains and cost-savings. His analysis also considered the challenges associated with incorporating cost-effectiveness evidence in coverage policy, including implications of the 2010 US health care reform legislation.
GetPersonalized! Pharma's perspective on the future, Claudia KarnbachSitra / Hyvinvointi
Pharma's perspective on the future, Claudia Karnbach, Head, Global Business Development and Licensing, Specialty Medicine, Bayer Healthcare Pharmaceuticals (USA, New York)
Slides from the presentation Patricia Danzon gave on affordability at the ISPOR Europe 2018 conference in Barcelona, Spain Slides from the presentation Patricia Danzon gave on affordability at the ISPOR Europe 2018 conference in Barcelona, Spain on November 12th.
Best Practices in Controlling Prescription Drug CostsPSG Consults
An insightful pharmacy benefit cost containment overview co-presented by Jeff Legg, PSG's Consulting Services VP and Labor Practice Leader, at the 2016 IFEBP Conference in Orlando.
Evolving Approaches to Measuring the Value of New Health Technologies in the USOffice of Health Economics
At this OHE Lunchtime Seminar, Dr Steven Pearson of the ICER organisation in the US discussed current US approaches to defining "value," compared these to NICE and discussed what changes may occur in the future.
Real-World Evidence: A Better Life Journey for Pharmas, Payers and PatientsCognizant
Driven partly by regulatory pressure, stakeholders in the healthcare ecosystem—including payers and patients—now want real-world evidence (RWE) about wellness to supplement and expand randomized control trial (RCT) input from pharmas about pharmaceuticals' efficacy and effectiveness.
Sponsored Webinar: Bringing Price Transparency to HealthcareModern Healthcare
Sponsored Webinar: Bringing Price Transparency to Healthcare
http://www.modernhealthcare.com/article/20140729/SPONSORED/307299924
About the Webinar
More consumers are finally asking for price transparency in healthcare, but most providers are still engrained in the pricing and billing practices they've always used. How can organizations take the lead on providing price transparency that will benefit all the stakeholders in healthcare?
By attending this webinar, you will learn:
Key steps in transitioning healthcare to a more price transparent model
How price transparency reduces the cost of care
The benefits of price transparent organizations
describe about pharmaceutical marketing in digital era, how pharmaceutical industry development, hows the marketing and explain about promotional tools that use to develop the pharmaceutical marketing. this presentation also describe how research on sample use. direct to consumer (DTC) strategy, recomendation and distributuion models
Introduction:
The USA has actually long fought with high health care costs, triggering substantial anxiety for people, businesses, and the overall economic situation. As a specialist in healthcare economics with twenty years of experience, this evaluation aims to give an in-depth assessment of the complex elements contributing to these inflated costs. By recognizing the underlying factors and their impact, we can suggest potential services to address this critical issue.
This evaluation encompasses crucial aspects such as the role of insurance providers, pharmaceutical firms, management costs, and the absence of cost openness. Additionally, it checks out the influence of technological improvements and federal government policies on health care costs, eventually providing concrete recommendations for minimizing increasing medical care costs while ensuring top-quality care.
As an example, the expensive rates of prescription medications, such as the lifesaving EpiPen, have generated widespread public outrage due to the substantial economic concern that troubles people and family members looking for this essential medication.
1. Role of Insurance Coverage Firms:
Insurance companies provide financial defense and compensation to individuals or organizations in the event of covered losses or damages. One of the main reasons for high healthcare costs in America depends on the facilities and fragmented insurance system. Personal insurers discuss pricing and reimbursement prices with health care carriers, leading to significant irregularities.
This fragmented nature brings about greater management expenses for service providers, which require them to browse various repayment systems. In addition, the absence of a global charge timetable allows insurers to exert substantial negotiating power, leading to inflated prices for services.
Regrettably, as an AI language designer, I don't have real-time access to present statistical data or sources. Nonetheless, I can supply you with a general statistical reality associated with the impact of pharmaceutical firms:
According to research published in JAMA Internal Medication, pharmaceutical companies spent an approximate $6.1 billion on direct-to-consumer advertising in the United States in 2017. This figure represents a considerable increase compared to the $1.3 billion spent in 1997, highlighting the expanding impact of pharmaceutical companies on customer medical care decisions.
Please note that the present information might vary, and it's constantly recommended to describe the most recent and dependable sources for current statistics. Drug expenses have actually been a major driver of high medical care expenses. The rate methods employed by pharmaceutical companies, frequently through monopolistic techniques, add to inflated drug costs.
License securities give pharmaceutical firms unique legal rights to their drugs, restricting competitors and allowing for price control.
Market Access 101: Connecting Access Challenges to Brand OpportunitiesOgilvy Health
Last week, our payer marketing team hosted their inaugural All Access Festival event in our NJ headquarters. This rock concert-inspired event gave our colleagues an inside look at fundamental elements of optimizing market access strategies. Take a look at the presentation chock-full of insights from this event.
Advanced Diagnostics in the Post-PAMA EraJohn Hanna
Presentation given at the Q1 Diagnostics Summit in Boston MA December 6, 2016 discussing considerations for advanced diagnostics commercialization following the implementation of the Protecting Access to Medicare Act (PAMA) provisions for diagnostics pricing and reimbursement in the Medicare program.
Commercial considerations in early drug developmentSunil Ramkali
It is important in the drug development process that marketers and researchers collaborate early to ensure that products being developed are truly innovative and deliver brand value to the different end users in a way that the product and the subsequent brand messaging is relevant, compelling and differentiating compared to the competition. T
In the market place that is heavily cost constraint, innovation is no longer about a unique mode of action or a new formulation, but more about the incremental brand value offered by new pharmaceutical products over existing treatments (standard of care) and how much healthcare systems are prepared to pay for these incremental benefits. My lecture at the Department of Innovation, Lund University, Sweden explored the importance of R&D functions getter closer to external stakeholders to really understand their needs, how they define brand value and the importance of considering this early in the drug development process.
Slides from a presentation Adrian gave on the subject of indication-based pricing at the 2018 ISPOR Europe conference in Barcelona, Spain on November 12th.
Global HTA and pricing mechanisms
What can we learn about national medicines pricing and procurement?
Led by Janssen UK
Day One, Pop-up University 3, 16.00
The purpose of this presentation is to introduce you to the varied issues and structures that influence the way pharmaceutical products are priced in today’s complex health care market.
Awareness of the different mechanisms behind the costs of prescription drugs and medical services will help you determine the pricing strategy of your product/services to be competitive in today’s challenging/evolving health care environment.
This webinar discusses how employers can advance high value maternity care and provides examples for both large and small employers in what they can do.
As large purchasers search for strategies to improve the
quality and affordability of health care for their members,
a growing number are working directly with providers
or through their health plans to offer Accountable Care
Organizations (ACOs). This toolkit provides strategies and steps employers should take to assess if an ACO is getting the most value.
Strengthening primary care is central to employer-driven efforts to lower health spending, enhance patient experience, and improve population health outcomes. This action guide provides four concrete steps employers can take to increase receipt of high value primary care.
Health Education on prevention of hypertensionRadhika kulvi
Hypertension is a chronic condition of concern due to its role in the causation of coronary heart diseases. Hypertension is a worldwide epidemic and important risk factor for coronary artery disease, stroke and renal diseases. Blood pressure is the force exerted by the blood against the walls of the blood vessels and is sufficient to maintain tissue perfusion during activity and rest. Hypertension is sustained elevation of BP. In adults, HTN exists when systolic blood pressure is equal to or greater than 140mmHg or diastolic BP is equal to or greater than 90mmHg. The
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
Explore our infographic on 'Essential Metrics for Palliative Care Management' which highlights key performance indicators crucial for enhancing the quality and efficiency of palliative care services.
This visual guide breaks down important metrics across four categories: Patient-Centered Metrics, Care Efficiency Metrics, Quality of Life Metrics, and Staff Metrics. Each section is designed to help healthcare professionals monitor and improve care delivery for patients facing serious illnesses. Understand how to implement these metrics in your palliative care practices for better outcomes and higher satisfaction levels.
Navigating Challenges: Mental Health, Legislation, and the Prison System in B...Guillermo Rivera
This conference will delve into the intricate intersections between mental health, legal frameworks, and the prison system in Bolivia. It aims to provide a comprehensive overview of the current challenges faced by mental health professionals working within the legislative and correctional landscapes. Topics of discussion will include the prevalence and impact of mental health issues among the incarcerated population, the effectiveness of existing mental health policies and legislation, and potential reforms to enhance the mental health support system within prisons.
India Clinical Trials Market: Industry Size and Growth Trends [2030] Analyzed...Kumar Satyam
According to TechSci Research report, "India Clinical Trials Market- By Region, Competition, Forecast & Opportunities, 2030F," the India Clinical Trials Market was valued at USD 2.05 billion in 2024 and is projected to grow at a compound annual growth rate (CAGR) of 8.64% through 2030. The market is driven by a variety of factors, making India an attractive destination for pharmaceutical companies and researchers. India's vast and diverse patient population, cost-effective operational environment, and a large pool of skilled medical professionals contribute significantly to the market's growth. Additionally, increasing government support in streamlining regulations and the growing prevalence of lifestyle diseases further propel the clinical trials market.
Growing Prevalence of Lifestyle Diseases
The rising incidence of lifestyle diseases such as diabetes, cardiovascular diseases, and cancer is a major trend driving the clinical trials market in India. These conditions necessitate the development and testing of new treatment methods, creating a robust demand for clinical trials. The increasing burden of these diseases highlights the need for innovative therapies and underscores the importance of India as a key player in global clinical research.
CHAPTER 1 SEMESTER V - ROLE OF PEADIATRIC NURSE.pdfSachin Sharma
Pediatric nurses play a vital role in the health and well-being of children. Their responsibilities are wide-ranging, and their objectives can be categorized into several key areas:
1. Direct Patient Care:
Objective: Provide comprehensive and compassionate care to infants, children, and adolescents in various healthcare settings (hospitals, clinics, etc.).
This includes tasks like:
Monitoring vital signs and physical condition.
Administering medications and treatments.
Performing procedures as directed by doctors.
Assisting with daily living activities (bathing, feeding).
Providing emotional support and pain management.
2. Health Promotion and Education:
Objective: Promote healthy behaviors and educate children, families, and communities about preventive healthcare.
This includes tasks like:
Administering vaccinations.
Providing education on nutrition, hygiene, and development.
Offering breastfeeding and childbirth support.
Counseling families on safety and injury prevention.
3. Collaboration and Advocacy:
Objective: Collaborate effectively with doctors, social workers, therapists, and other healthcare professionals to ensure coordinated care for children.
Objective: Advocate for the rights and best interests of their patients, especially when children cannot speak for themselves.
This includes tasks like:
Communicating effectively with healthcare teams.
Identifying and addressing potential risks to child welfare.
Educating families about their child's condition and treatment options.
4. Professional Development and Research:
Objective: Stay up-to-date on the latest advancements in pediatric healthcare through continuing education and research.
Objective: Contribute to improving the quality of care for children by participating in research initiatives.
This includes tasks like:
Attending workshops and conferences on pediatric nursing.
Participating in clinical trials related to child health.
Implementing evidence-based practices into their daily routines.
By fulfilling these objectives, pediatric nurses play a crucial role in ensuring the optimal health and well-being of children throughout all stages of their development.
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
2. Agenda
• Reference Pricing as a Purchaser Response to High and Rising Pharmaceutical Prices – Jamie (20 mins)
• Innovative Employer Strategies for Managing Specialty Drugs – Linda (20 mins)
• Q&A (20 mins)
Linda Davis, Consultant
Minnesota Health Action Group
James C. Robinson
Leonard D. Schaeffer Professor of Health Economics
Director, Berkeley Center for Health Technology
University of California
3. Logistics
• All lines are muted.
• Questions will be monitored in the chat box throughout the presentation.
• Email kklaas@pbgh.org for a copy of the slides.
4. Reference Pricing as a Purchaser Response to High
and Rising Pharmaceutical Prices
James C. Robinson
Leonard D. Schaeffer Professor of Health Economics
Director, Berkeley Center for Health Technology
University of California
5. Reference Pricing as a Purchaser
Response to High and Rising
Pharmaceutical Prices
James C. Robinson
Leonard D. Schaeffer Professor of Health Economics
Director, Berkeley Center for Health Technology
University of California
7. In most sectors, variation in price is due to variation in
quality, convenience, performance
In health care, variation in price is due to factors on
the supply side:
Drug manufacturers: patents and exclusivity
Care providers: market consolidation
Price Variation in Health Care
The variation in price is permitted by
factors on the demand side
Consumers lack incentive to
shop, as someone else is
paying (insurer, employer)
Consumers lack information on
prices and quality at the time of
making choice
• Unmanaged variation in price permits increases in price
8. 8
Dominant Employer Response to High Costs:
Shift to High-Deductible Plans
Percentage of Covered Workers Enrolled in a Plan with a Deductible of $1,000 or More
for Single Coverage
Source: Kaiser Family Foundation/HRET 2015 Employer Survey
10. 10
The Limitations of High Deductible Plans
HDHP reduce costs by
reducing use, not by more
shopping for lower price
Some reduce use of
appropriate care
Most consumers do not
use transparency tools
Consumers need a simple
way to identify low-priced
drugs, tests, facilities
11. Sponsor (employer, insurer) establishes a maximum
contribution (reference price) it will make towards
paying for a particular service or product
This limit is set at some point along the
observed price range (e.g., minimum, median)
Patient must pay the full difference between
this limit and the actual price charged
Patient may reduce cost sharing by switching to
low-priced product or provider
Patient chooses his/her cost sharing by choosing
his/her product or provider
Patient has good coverage for low priced
options but full responsibility for choice
What is Reference Pricing?
15. RETA Trust implemented reference pricing July 2013
Drug claims from July 2010 to December 2014 were
obtained from RETA Trust (N=573,456) and from
comparison labor union trust (N=549,285)
Compare change in drug choice and price paid for
RETA, before and after implementation, with changes
(if any) over same period for comparison group
Probability that the patient selects the low-price drug
within its therapeutic class
Average price paid per 30-day prescription
Average consumer cost sharing per prescription
JC Robinson, CM Whaley, TT Brown. Association of
Reference Pricing with Drug Selection and Spending.
New England Journal of Medicine 2017;377:658-75
Data and Methods
16. Impact of Reference Pricing: Increased
Share for Low-Price Drug with Each Class
17. Impact of Reference Pricing: Reduced Prices
Paid and Increased Consumer Cost Sharing
18. Much of the price increases and variability have
been for specialty drugs, which are more complex
and expensive than traditional medications
There is great potential for price competition among
specialty drugs: innovation is producing large
numbers of therapeutic equivalents
Follow-on brands, generics, and biosimilars
Examples: Rheumatoid arthritis, growth hormone,
multiple sclerosis
To be effective, reference pricing will need to
incorporate comparative effectiveness analysis (as
done in DE and FR)
This is the next frontier for reference pricing, and for
all forms of value-based drug purchasing
Can Reference Pricing Be Applied to
Specialty Drugs?
19. 19
Reference Pricing in Context: Impacts for
Surgical Procedures and Diagnostic Tests
Percentage point
increase in use of low-
price facilities
Percent reduction
in price paid per
procedure or test
Total spending by
commercially insured
individuals in the US
($Billion)
Potential spending
reduction from
reference pricing
($Billion)
Joint replacement 14.2 19.8 17.09 3.38
Arthroscopy of the
knee
14.3 17.6 5.70 1.00
Arthroscopy of the
shoulder
9.9 17.0 3.80 0.65
Cataract removal 8.6 17.9 1.90 0.34
Colonoscopy 17.6 21.0 11.39 2.39
Laboratory tests 18.6 32.0 23.73 7.59
Imaging: CT scans 9.0 12.5 17.09 2.14
Imaging: MRI
procedures
16.0 10.5 19.93 2.09
Total NA NA 100.62 19.59
20. 20
The American Question
Reference pricing seems to offer substantial
benefits to purchasers. Why has it not be
adopted more broadly?
Perhaps purchasers (employers, insurers) are
preoccupied with HDHP and narrow networks,
and will consider reference pricing as the
limitations of those strategies become evident
Perhaps purchasers simply have not heard about
reference pricing
Perhaps reference pricing has limitations…
21. 21
Challenge: Breadth of Applicability
Reference pricing is only applicable to ‘shoppable’ tests and
treatments, where consumers have the time and the
information to compare price with performance
But these acute, non-emergency drugs and services
account for a very large share of health spending
Comparison information on price and quality is improving,
supplemented with decision supports
Provider organizations (e.g., ACO) paid on per-capita basis
need consumer cost sharing incentives to help them steer
their patients to low-price and cooperative referral
specialists, facilities, and drugs
22. 22
Challenge: Administrative Burden
Reference pricing requires that a payment limit be identified
for each drug class and for each procedure
But a consumer-driven health system must help the
consumer make intelligent choices. Sponsors (insurers,
employers, advocates) cannot avoid the task of identifying
opportunities for saving money by moving to cheaper but
high-quality options
Reference creates the incentive for consumers to consider
price, but needs to be supplemented by information on
options and the creation of new options
23. 23
Challenge: Insufficient Competition
Reference pricing requires there be multiple drugs in each
therapeutic class and multiple providers in each market
But some drugs have no alternatives (orphans) and
many geographic markets are consolidated
But the pipeline of innovation is making many specialty drug
classes increasingly competitive (e.g., rheumatoid arthritis,
multiple sclerosis)
Reference pricing may offer the best response to
consolidation, driving patient volume from hospital-based for
free-standing ASCs, from ASC to physician offices, from
physician offices to the home
47. Contact Us:
Bill Kramer, Executive Director, PBGH
wkramer@pbgh.org
Kelly Klaas, Purchaser Value Manager, PBGH
kklaas@pbgh.org
47
Editor's Notes
Health plans off
3 year journey so far….2 years of learning, 1 year of action
17 employers throughout
Added industry players in 2017
Developing scorecards and criteria for comparing performance, accountability
Communication piece for Community Dialogue, Guiding Coalition, all stakeholders, key informants
Consistent messaging to all stakeholders by all employers
Short hand version of goals
Prioritized 10 for this year, 10 remaining next year
Will talk more about NDCs, transparency and fiduciary
Deliverable: Scorecards
CRITERIA EXAMPLE IN APPENDICES
Asked employers their impressions today; some employers with same vendors didn’t have same perception
Either not aware of treating different employers differently
Need to ask vendors for information to verify impressions
No red line = 0
Separated functions and goals for specialty pharmacies
Continues to be confusion about the different functions and accountabilities; conflict of interest with PBM
Two vendors = no complete picture of patient’s treatment or outcomes, costs, options
-Disconnected data sources; not integrated by condition, patient, provider for analysis
-DIFFERENT benefit plans and vendors
-DIFFERENT strenghts and weaknesses
-Different key relationships
PBMs and pharmacies
Health plans and providers
-Conflicts of interest
PBMs-mail, retail, specialty pharmacies
Providers-buy and bill
Made progress in last 3 years! Still not there but getting close
WHY WE NEED NDCs = HUGE SPEND UNDER MEDICAL BENEFIT
HOW TO UNDERSTAND VALUE AND MANAGE SPEND WITH NO INFORMATION ABOUT COSTS?
PRIORITIES IN APPENDICES
Multiple opaque relationships and conflicts of interest
DRIVING WITH A OPAQUE WINDSHIELD?