Employers’ Prescription for Affordable Drugs

Led by PBGH, The Employers’ Prescription for Affordable Drugs (EmployersRx) is a coalition of The Purchaser Business Group on Health, National Alliance of Healthcare Purchaser Coalitions, The Erisa Industry Committee (ERIC), American Benefits Council, Silicon Valley Employers Forum and HR Policy Association. EmployersRx supports policies that would require PBMs to make pricing data available to payers and compel drug companies to report and justify price increases for some medications. The coalition also seeks to strengthen competition and remove barriers that stifle the development and use of generic drugs and biosimilars.

BACKGROUND

EmployersRx aims to mobilize large employers to drive down drug costs by educating and influencing public policies. Built on the tenets of transparency, competition and value, EmployersRx supports public policies that drive down the cost of drugs while preserving true innovation as part of a value-based health care system.

We believe that strong pharmacy benefit manager (PBM) reforms, which restore transparency and competition to the market, are critical to allowing employers to continue to offer affordable, quality health care to employees and their families. The complex rebate structure and total lack of transparency with respect to PBMs makes it difficult for employers to manage prescription drug costs. Federal legislation requiring robust transparency and accountability from PBMs to employers is critical for employer efforts to lower prescription drug costs.

OUR PRESCRIPTION

Transparency

Many drug manufacturers invest a great deal of money in research and development. But those costs and other factors that form the basis for establishing prices are extremely opaque. Increasing transparency at every level of the supply chain will provide consumers, purchasers and other stakeholders the information needed to ensure that effective treatments are obtained at a fair and reasonable cost.

Competition

The drug marketplace is characterized by counterproductive incentives, inefficiencies and anti-competitive practices that obstruct healthy price competition. Many newer drugs benefit from government-sanctioned monopolies through patent and market-exclusivity laws. Leveling the playing field by requiring fair business practices would encourage competition and drive down the cost of prescription drugs.

Value

Employers and employees pay more than ever for prescription drugs. But often the price is not aligned with the value of the product. The business models of some prescribing physicians and intermediaries, such as PBMs, often are misaligned with the interests of employers and patients, resulting in higher costs. We must stop rewarding payment structures and incentives that result in higher costs, and we must ensure that drugs are priced according to their value as a therapeutic agent.

Of particular concern for health care purchasers are the proliferation of specialty drugs with small markets. While these innovative therapies can be highly effective, their very high costs can be prohibitive for patients and purchasers. EmployersRx looks forward to working with policymakers to identify policies to balance the clinical benefit of specialty drugs with their overall cost to patients and purchasers.

COALITION MEMBERS