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Specialty Pharmacy



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The Evolving Pharmacy Landscape
A Business Group/BCBSA collaboration focused on consumers' perspectives on pharmacy issues, such as coupons and medication costs; paired with employers' perspectives.
Oct 18, 2019
The Evolving Pharmacy Landscape Infographic
An infographic highlighting consumers' and large employers' perspectives on pharmacy issues, such as coupons, medication costs and government intervention.
Oct 18, 2019
Today's Evolving Pharmacy Landscape: The Consumer Perspective
This webinar highlights the results of a recent Business Group/BCBSA collaboration focused on consumers' and large employers' perspectives on pharmacy issues.
Oct 18, 2019
HIV/AIDS: Despite Progress, Much Work Remains
This Issue Brief details the transformation of the HIV/AIDS treatment landscape and offers suggestions for what employers can do to help eradicate the disease once and for all.
Sep 19, 2019
2020 Large Employers' Health Care Strategy and Plan Design Survey: Executive Summary
This year, the Large Employers' Health Care Strategy and Plan Design Survey included questions a range of topics. The executive summary covers 7 highlights from the full report.
Aug 13, 2019
2020 Large Employers' Health Care Strategy and Plan Design Survey: Full Report
This year, the Large Employers' Health Care Strategy and Plan Design Survey included questions to provide insight into large employers' views on the rapidly changing health care landscape. Large employers were asked about their evolving role in bringing about change in health care, their thoughts about proposed policy changes and the position of virtual solutions in their offerings.
Aug 13, 2019
2020 Large Employers' Health Care Strategy and Plan Design Survey: Pharmacy Costs and Strategies
This year, the Large Employers' Health Care Strategy and Plan Design Survey included questions focused on solutions to high-cost therapies and other specialty medications. In addition, employers were asked about copay assistance programs and point-of-sale rebate programs.
Aug 13, 2019
2020 Large Employers' Health Care Strategy and Plan Design Survey: Policy
This year, the Large Employers' Health Care Strategy and Plan Design Survey included questions focused on employers' perspectives on Medicare for All and Medicare Expansion solutions. Employers were also asked what role the government could play around high-cost therapies.
Aug 13, 2019
Results from the 2020 Large Employers' Health Care Strategy and Plan Design Survey: Press Briefing
This year, the Large Employers' Health Care Strategy and Plan Design Survey included questions to provide insight into large employers' views on the rapidly changing health care landscape. The press briefing covered 10 key insights into how large employers are approaching the delivery system, policy, pharmacy, health care cost management and more.
Aug 13, 2019
What Your CEO is Reading - Zolgensma: A New High for Drug Therapies at $2.12M
What Your CEO is Reading - Zolgensma: A New High for Drug Therapies at $2.12M.
May 29, 2019
Let's Get a Grip on Arthritis
This installment in the Specialty Pharmacy Management Series highlights challenges surrounding access to arthritis treatment and offers various employer plan design considerations that are centered on affordability, care management (continuity of care) and access to insurance coverage and providers.
Feb 13, 2019
Multiple Sclerosis: New Evidence, New Treatments
This guide recommends actions for employers to support employees and dependents living with multiple sclerosis, including medical and pharmacy plan design considerations, workplace supports to help employees with MS stay productive in the workplace, and integration of employee assistance programs to help patients stay happy and healthy.
Jan 30, 2019
New Entrants Create Price Competition & Drive New Formulary Solutions in Hepatitis C Market
The approvals and availability of new drugs for the treatment of Hepatitis C have made national headlines because of their superior efficacy and also because of their extremely high costs. The information included in this Employer Alert is intended to help benefit managers understand and make decisions related to this high-profile issue.
Jan 8, 2019
Drug Manufacturer Patient Assistance Programs
This Numbers You Need Slide looks at employers' perspectives and programs around patient assistance programs.
Nov 2, 2018
Manufacturer Rebates
This Numbers You Need Slide looks at employers' perspectives around the rebate model and alternatives to that model.
Nov 2, 2018
Rebate Models and Alternatives
This Numbers You Need Slide looks at employers' perspectives around the rebate model and alternatives to that model.
Nov 2, 2018
Top Cost Drivers of Health Care Costs
This Numbers You Need Slide looks at the top cost drivers that are effecting rising health care costs
Nov 2, 2018
Better Oncology Care: Realizing the Potential
This webinar explores the evolving role of pharmacotherapy in the treatment of cancer. Learn about the latest advancements, including gene and cell therapy, come to understand the role of integrated care to achieve the best experience and outcomes for patients and develop an understanding of what employers should consider to achieve access and affordability for members who have cancer.
Oct 10, 2018
What is ICER and Why Should Employers Care?
NBGH September 18, 2018 Webinar Slides from Dr. Steve Pearson (ICER) and Dr. Surya Singh (CVS Health)
Sep 18, 2018
Coming Down the Pipeline: What's on the Horizon and How to Mitigate Your Plan's Exposure to Risk
This webinar takes a look at the historical impact of big-ticket specialty medications that are driving trend and learn what to look out for in the near future in terms of critical and/or costly new drugs entering the market.
Sep 13, 2018
Using Genetics To Guide Treatment
The world of genetics is quickly unfolding, having tremendous impact on the care received by employees and employers' health care costs. This webinar offers a snippet of information on each corner of genetics in health care: pharmacogenomics, genomic sequencing and molecular testing.
Sep 6, 2018
Innovative Approaches to Cancer Care Delivery (Part II): Future of Oncology Care
In this webinar, hear a widely-recognized oncology expert from City of Hope, an NCI-designated comprehensive cancer center, describe the practical and innovative approaches employers are using to support employees seeking personalized and highly-targeted cancer care. This webinar also highlights opportunities for employers to offer benefits and oncology management programs that affordably provide access to best-in-class care.
Aug 21, 2018
What Your CEO Is Reading - Challenging Pharmaceutical Rebates
Media attention has continued focus on the dysfunction in the pharmaceutical supply chain model and its contribution to high and rising drug prices.
Aug 2, 2018
What Your CEO Is Reading - Drug Price Reduction Efforts
This WYCIR examines efforts by the Trump Administration to lower drug prices, and corresponding industry reaction.
Jul 25, 2018
Pharmacy Benefits Among Large Employers: A National Business Group on Health Infographic
The information provided in this infographic has been taken from a collection of Quick Surveys performed by the Business Group.
Apr 4, 2018
What Your CEO is Reading: Cigna to Acquire Express Scripts
Cigna is nearing a deal to buy Express Scripts in a transaction that is believed to be worth more than $50 billion.
Mar 8, 2018
What Your CEO Is Reading: Point of Sale Rebates
UnitedHealth Group to pass pharmaceutical manufacturer rebates to consumers at the point of sale (POS)
Mar 7, 2018
Specialty Pharmaceuticals: High Prices Getting Higher and What Employers Can Do
Expenditures for specialty drugs continue to grow faster than any other component of health care spend, despite being used by only 2% of the population. Open to learn more about what your peers are doing and how you can leverage shifting industry dynamics to lower your pharmaceutical spend and enhance the value of care your employees receive.
Jan 11, 2018
An Employer's First Steps Toward "Paying for Value": Amgen Tackles Value-Based Insurance Design
In this webinar, Amgen Inc. discusses the first steps they have taken, in partnership with University of Michigan, to implement a value-based insurance design approach.
Dec 13, 2017
Value-Based Drug Purchasing
Health plans, PBMs, pharmaceutical manufacturers and employers are beginning to implement value-based drug purchasing (VBP) arrangements, with the hope of changing the fee-for-service reimbursement paradigm for drugs. This fact sheet lays out several drug VBP strategies and details early results from pilot programs.
Dec 11, 2017
What Your CEO is Reading - CVS Health to Acquire Aetna
Open to learn more about the proposed merger and whether and how it may affect your company's health benefits and future health strategy.
Dec 6, 2017
High-Cost Claimants Webinar Series - Hemophilia
In this webinar, an expert from the National Hemophilia Foundation discusses the rare disorder of Hemophilia and ways to significantly drive down costs and improve outcomes for patients afflicted by this disease.
Nov 30, 2017
Biosimilars: Part II
Is your organization prepared to achieve savings through biosimilar utilization? In this webinar, Wal-Mart Stores, Inc. leads biosimilar manufacturers Pfizer and Sandoz in a round-two discussion centered on how employers can best incorporate biosimilars into plan design.
Nov 28, 2017
Preventive Health Through Genetics: The New Company Health Benefit
This webinar presentation details how genetics is changing the role of prevention in health care today and how leading companies, such as SAP, are turning to genetics as an integral pillar of their overall preventive health strategy.
Oct 4, 2017
Large Employers' 2018 Health Care Strategy and Plan Design Survey
Results from this survey indicate that employers are looking to new methods of controlling health care costs, improving outcomes and increasing satisfaction for their employees, both through demand-side (e.g., implementing CDHPs, modifying plan design and cost-sharing strategies, adding price transparency tools) and supply-side initiatives (e.g., telehealth, on-site clinics, Centers of Excellence, Accountable Care Organizations, etc.).
Aug 7, 2017
Large Employers' 2018 Health Care Strategy and Plan Design Survey: Chart Pack
Results from this survey indicate that employers are looking to new methods of controlling health care costs, improving outcomes and increasing satisfaction for their employees, both through demand-side (e.g., implementing CDHPs, modifying plan design and cost-sharing strategies, adding price transparency tools) and supply-side initiatives (e.g., telehealth, on-site clinics, Centers of Excellence, Accountable Care Organizations, etc.).
Aug 7, 2017
An Overview: State and Federal Prescription Drug and Pharmacy Bills, Their Implications, and Likelihood of Passage
This webinar evaluates current and potential policy options proposed by both state and federal policy makers, discusses how these policy options may impact employers and employer pharmacy spending trends, and assesses the outlook for adoption of various policies.
Jul 20, 2017
Biosimilars: A Checklist
Is your organization prepared to achieve savings through biosimilar utilization? Learn how to manage these new drugs in plan design!
Jul 11, 2017
NBGH Comment Letter to the FDA regarding Interchangeability Guidance for Industry
NBGH comments to outline that our membership supports the robust uptake of biosimilars in the marketplace, while ensuring that patients have access to safe, high quality treatments and therapies.
May 17, 2017
Rx Coupons – Consumer saver or cost driver?
This Rx Alert shares real-time, actionable insights on how to address copay coupon management in plan design.
Mar 20, 2017
Drug Manufacturer Delays Market Entry of Drug after Pricing Backlash
Recently, Marathon Pharmaceuticals announced that it was pausing a planned March U.S. launch of a drug (a corticosteroid) used to treat a rare form of muscular dystrophy, Duchenne’s, amid mounting criticism of its proposed $89,000-a-year price.
Feb 16, 2017
Biosimilars: A Checklist
Is Your Organization Prepared to Achieve Savings Through Biosimilar Utilization? The following checklist provides tips for getting you there.
Feb 3, 2017
Policy Brief - Policy Recommendations to Promote Sustainable, Affordable Pricing for Specialty Pharmaceuticals
This policy brief describes the challenges large employers face in managing high-priced specialty drugs, examines ways to better manage them and offers public policy recommendations that would create a more favorable environment for financial sustainability and affordability of these medications.
Jan 27, 2017
The Impact of Specialty Pharmacy on Your Business
The purpose of this survey is to look at the impact of specialty pharmaceuticals, and future strategies that employers are considering to control costs and ensure employees and their families have access to high value treatments. Thirty-three members of the Business Group responded to this survey.
Dec 16, 2016
Rx Alert: High-Priced Combination Drugs
This alert gives a look into the increase of combined drug therapies and the rising concern of affordability.
Dec 9, 2016
What Your CEO is Reading - Health Care Growth Accelerates
This newsletter highlights recent news articles about how the U.S. will again start to see a rise in costs--the biggest since the recession--after years of slowed growth in health care spending.
Dec 9, 2016
Rx Alert: DAW Penalties May Artificially Inflate Discount Performance of Generic Drugs
This Rx Alert describes how DAW penalties may be used to artificially inflate discount performance of generic drugs and provides steps that employers can take to ensure that this does not happen.
Nov 14, 2016
Remicade® Biosimilar Will Hit Market in November
The manufacturer of the biosimilar INFLECTRA® expects to begin shipping its competitor to REMICADE®, a drug used to treat rheumatoid arthritis and other inflammatory conditions, in late November at a discount of 15% ($946 vs. $1,113) compared to REMICADE®.
Oct 31, 2016
Specialty Pharmacy Costs, by Therapy Class
This Numbers You Need chart examines how pharmacy costs are projected to increase over the next three years for the most expensive specialty drug therapy classes.
Oct 11, 2016
FDA Approves Fourth Biosimilar, But Market Entry Date Unclear
Though the FDA approved Amjevita™ last week, a specialty medication used to treat arthritis and other inflammatory conditions and a competitor to Humira®, the top-selling specialty pharmacy medication, it is unclear when it will hit the market.
Sep 30, 2016
What Your CEO is Reading - Anti-Inflammatory Specialty Drugs
This newsletter highlights a New York Times articles about a new effort to address high-priced anti-inflammatory specialty medications taken by millions of people for conditions such as rheumatoid arthritis, psoriasis and Crohn’s disease. The rising costs associated with these drugs are a result of the increase in the price of these medications and an increase in the number of patients using them.
Sep 12, 2016
Employers' Use of Management Tactics for Specialty Pharmacy Benefits
This Numbers You Need chart looks at the prevalence of various pharmacy management techniques for managing specialty utilization and costs.
Aug 19, 2016
Specialty Pharmacy Costs Continue to Increase at Unsustainable Pace
This Numbers You Need chart shows a comparison of the prescription drug trend projections for traditional pharmacy vs. specialty pharmacy.
Aug 19, 2016
Contributions to Net Plan Specialty Costs by Category
This Numbers You Need chart looks at the conditions where specialty pharmacy dollars are spent.
Aug 9, 2016
Specialty Pharmacy Management: A Checklist
This checklist provides tips for staying ahead of the curve when it comes to managing specialty pharmacy in plan design.
Aug 2, 2016
Biologics Competition: An Update on the Market and Future Policy Actions
Understanding how public policy will impact employers ability to utilize biosimilar drugs in place of high price branded specialty/biologic drugs.
Jul 29, 2016
Rx Alert: Compounds - They're Back!
Rx Alert shares real-time, actionable insights based on information received through our National Committee on Pharmacy Benefits and Specialty Medicine as well as relationships with PBMs, consultants and employer members that can help you identify the next issue impacting the quality and cost of your pharmacy program.
Jul 20, 2016
Comments to the FDA Commissioner Supporting Increased Regulation of Drug Compounding Outsourcing Facilities
The National Business Group on Health submitted comments to the FDA supporting requiring drug compounding outsourcing facilities meet current good manufacturing practices.
Jul 14, 2016
Comments to the FDA Commissioner Supporting Limited Anticipatory Compounding at Hospital Pharmacies
The National Business Group on Health submitted comments to the FDA supporting regulatory approaches that would limit hospital pharmacies ability to anticipatory compound drugs potentially reducing unnecessary expenditures and increasing patient safety.
Jul 14, 2016
Comments to the FDA Commissioner Supporting Limiting Drug Compounding to Decrease Costs and Increase Patient Safety
The National Business Group on Health submitted comments to the FDA supporting requiring valid prescription orders before pharmacies can compound drugs, allowing for limited anticipatory compounding and limiting compounded drug distribution.
Jul 14, 2016
Comments to the FDA Supporting Regulatory Approach to Approval of Biosimilars
The National Business Group on Health submitted comments to the FDA strongly supporting a regulatory environment which favors the robust uptake of high quality, safe, and efficacious biosimilars.
Jul 12, 2016
Letter to the FDA Commissioner Supporting Efforts to Assure a Favorable Regulatory Environment to Encourage Robust Uptake of Biosimilars
Recently, the Business Group sent comments to FDA Commissioner Dr. Robert M. Califf urging the agency to continue its thoughtful deliberation of issues related to market adoption of biosimilars, as it develops its guidance around interchangeability.
Jun 3, 2016
What Your CEO is Reading - Value-Based Contracts for Specialty Drugs
This newsletter highlights a recent news article on value-based pricing agreements, which is when manufacturers share in the financial risk if medications don't work as intended.
May 13, 2016
What Your CEO is Reading - Drug Pricing
This newsletter highlights recent articles that report on drug spending in 2015 based on data from the nation's two largest PBMs. Spending increased by approximately 5% in 2015. This increase, while twice the consumer price index (CPI), is significantly less than that of 2014, despite similar price inflation patterns - a sign that aggressive management of prescription drugs by the PBMs is working to help mitigate overall drug spend and to at least temper inflationary forces.
Mar 22, 2016
Californians to Vote on Ballot Referendum to Reduce State Rx Prices to V.A. Level
In November, Californians will vote whether to require the state to pay prices for prescription drugs no higher than those paid by the U.S. Department of Veteran’s Affairs (V.A.) which can be up to 24% lower.
Feb 9, 2016
New Hepatitis C Drug Could Reduce Employers’ Specialty Pharmacy Spend
Recently, the FDA approved a new, highly-effective Hepatitis C drug (Zepatier) that will join the 6 other Hepatitis C drugs approved since 2013.
Feb 9, 2016
Specialty Drug Approvals and Sales
This Numbers You Need chart details the rising number of specialty drug approvals over the last few years, and the estimated sales figures for top specialty drugs.
Dec 4, 2015
New Jersey Is 17th State to Add Rules that Could Inhibit Specialty Pharmacy Competition
Last week, New Jersey became the 17th state to pass a law that could make it harder for pharmacists to substitute interchangeable biosimilars for brand biologic medications.
Nov 17, 2015
What Your CEO is Reading - New Blockbuster Cholesterol Drugs
This newsletter highlights the FDA's recent FDA approval of a groundbreaking, cholesterol-lowering drug, Praulent®, belonging to a class called PCSK-9 inhibitors. Other cholesterol-lowering drugs or PCSK-9 inhibitors are expected to be introduced soon. These drugs are designed as long-term therapies for high cholesterol and, as such, target high levels of low-density lipoprotein cholesterol (LDL-C or "bad cholesterol"), often the culprit in heart disease.
Jul 31, 2015
Senate May Vote Soon on House-Passed Bill to Spur Biomedical Innovation
Last Friday, the House of Representatives passed a bipartisan bill (344 to 77) that would speed up the FDA approval process for new drugs and devices.
Jul 14, 2015
PCSK-9 Inhibitors: Next-Level Cholesterol Management
Employer Alert introducing the new PCSK-9 inhibitor drug class and providing guidance for employers in preparation for the imminent market launch of these medications.
Jun 17, 2015
Plaintiffs Seek Class Action Status for Insurer’s Denial of New Hepatitis C Drug
In separate lawsuits, two patients, one with an individual insurance policy and one with a government employee plan, have sued a major national insurer for denying coverage of a new Hepatitis C medication.
Jun 2, 2015
FDA under Pressure to Speed Drug Approvals and Okay Off-Label Use
Parts of a House bill designed to spur biomedical innovation would also streamline the FDA approval process for new drugs and reduce FDA restrictions on communications by manufacturers about off-label use of medications.
May 18, 2015
California, Other States Consider Requiring Disclosure of Costs for High-Priced Specialty Medications
In response to high prices for specialty pharmacy medications, California and several other states are considering bills that would require manufacturers to disclose detailed cost information publicly each year.
May 5, 2015
Colorado Is 9th State to Inhibit Biosimilar Substitution for Brand Biologics
Colorado recently became the 9th state to pass a law making it harder for pharmacists to substitute biosimilars for brand biologic medications.
Apr 23, 2015
New Specialty Medicines for Cholesterol Fuel Cost Woes
The FDA’s expected approval of several new types of cholesterol drugs as early as this summer is adding fuel to the growing concern about pricing for highly effective, but very expensive specialty medications.
Mar 3, 2015
Right Care, Right Place, Right Health Professional: Site of Care Benefit Manager Guide
This Benefit Manager Guide reviews the reasons employers are paying attention to where their employees seek care and provides best practice recommendations to encourage employees to obtain care from high-value settings.
Feb 27, 2015
2015 Pharmacy Trends and Hot Topics
The purpose of this webinar is to highlight pharmacy trends and hot topics facing employers in 2015 and to showcase how one employer has successfully managed pharmacy costs.
Feb 5, 2015
The Impact of New Hepatitis C Drugs and Employer Management Techniques
The purpose of this survey was to determine what benefit management techniques employers have put in place for the new hepatitis C drugs Sovaldi and Olysio, and the estimated impact of covering these new medications. Forty-two members of the Business Group responded to this survey.
Sep 9, 2014
What Your CEO is Reading - Specialty Pharmaceuticals
The article highlights concerns from insurers and employers about the dramatic rise in costs for specialty pharmaceuticals even as inflation in overall health care costs and traditional pharmaceuticals has slowed.
Jun 4, 2014
Treating rheumatoid arthritis: “Non-biologic” drugs are a better first choice
This resource is intended to engage consumers in important conversations with their physicians about appropriate treatment for rheumatoid arthritis. It was developed by Consumer Reports in cooperation with the American College of Rheumatology for Choosing Wisely, a project of the ABIM Foundation.
Oct 23, 2013
The Buzz on BRCA Gene Mutations: What Employers Need to Know
The resources and information are intended to assist employers and benefit managers in understanding and explaining the issues around the high-profile issue of the BRCA gene mutation and breast cancer.
May 23, 2013
Employer Solutions to Escalating Specialty Pharmacy Costs
Provides potential solutions for employers to better manage the costs of specialty medications without limiting access to life-improving therapies.
May 1, 2013
Cancer as a Chronic Disease: Evidence-Based Pharmaceutical Treatments and Cost Management Recommendations for Employers
Provides employers with five recommendations to support employees with cancer by adhering to evidence-based treatment guidelines and controlling oncology medication costs.
Apr 1, 2013

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