2nd National Employer Survey on Specialty Pharmacy Benefits

Please complete the survey by December 14th. Thank you!

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* 1. If you would like to receive a copy of the survey results or be eligible for the drawing, please complete the following information:

Name

Company

Email Address

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* 2. In what state is your company located?

State:

Demographics

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* 3. What is the size of your active employee population?

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* 4. What is the average age of your organization's active and covered population?

	Under 30	31 - 45	46 - 65
Active population	Active population Under 30	Active population 31 - 45	Active population 46 - 65
Covered population (e.g. dependents)	Covered population (e.g. dependents) Under 30	Covered population (e.g. dependents) 31 - 45	Covered population (e.g. dependents) 46 - 65

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* 5. Select the industry type that best describes your company:

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* 6. How do you primarily fund your health benefits?

Fully-insured

Self-insured

Understanding Specialty Pharmacy Benefits

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* 7. Indicate your level of understanding of specialty pharmacy benefits:

High

Above Average

Average

Very Little

Low

High

Above Average

Average

Very Little

Low

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* 8. Indicate your executive leadership’s level of interest in understanding specialty pharmacy benefits:

High

Above Average

Average

Very Little

Low

Do not know

High

Above Average

Average

Very Little

Low

Do not know

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* 9. Indicate your organization’s level of involvement in working with your specialty pharmacy benefits (e.g. how involved you are with plan design, contracting, management): (choose one)

None: Rely fully on consultant/PBM/health plan

Minimal: Rely primarily on consultant/PBM/health plan

Moderate: Work collaboratively with consultant/PBM/health plan

Significant: Work collaboratively and are very involved with consultant/PBM/health plan but do not lead the effort

Very significant: Internal staff is wholly involved in all aspects, including leadership of the activity

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* 10. Indicate which service provider you primarily contract with for specialty pharmacy benefits and services: (choose one)

Pharmacy benefits manager

Health plan / Insurer

Specialty pharmacy

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* 11. Which service providers support your organization for each of the following specialty pharmacy services ? (check all the apply)

	Benefit Design	Service Provider Contracting	General Management
Service provider chosen above	Service provider chosen above Benefit Design	Service provider chosen above Service Provider Contracting	Service provider chosen above General Management
Benefits consultant	Benefits consultant Benefit Design	Benefits consultant Service Provider Contracting	Benefits consultant General Management
Pharmacy consultant	Pharmacy consultant Benefit Design	Pharmacy consultant Service Provider Contracting	Pharmacy consultant General Management
Do on own / In-house	Do on own / In-house Benefit Design	Do on own / In-house Service Provider Contracting	Do on own / In-house General Management

Medical, Pharmacy and Specialty Pharmacy Costs

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* 12. What was your company’s total combined medical and pharmacy claims costs paid in 2011 (or most recent plan year)?

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* 13. What was your company’s per employee combined medical and pharmacy paid claims costs in 2011 (or most recent plan year)?

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* 14. What percentage of your company paid medical costs are for specialty pharmacy drugs and related services?

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* 15. What percentage of your company paid prescription drug costs are for specialty pharmacy drugs and related services?

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* 16. How much have your specialty pharmacy benefit costs increased over the past 3 years?

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* 17. What percentage of your pharmacy rebates were for specialty pharmacy drugs?

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* 18. Indicate the top three disease states that incur the greatest specialty drug costs for your organization:

	#1 Disease State	#2 Disease State	#3 Disease State
Arthritis	Arthritis #1 Disease State	Arthritis #2 Disease State	Arthritis #3 Disease State
Multiple Sclerosis	Multiple Sclerosis #1 Disease State	Multiple Sclerosis #2 Disease State	Multiple Sclerosis #3 Disease State
Cancer ( oncology or hematology)	Cancer ( oncology or hematology) #1 Disease State	Cancer ( oncology or hematology) #2 Disease State	Cancer ( oncology or hematology) #3 Disease State
Growth hormone deficiency	Growth hormone deficiency #1 Disease State	Growth hormone deficiency #2 Disease State	Growth hormone deficiency #3 Disease State
HIV/AIDS	HIV/AIDS #1 Disease State	HIV/AIDS #2 Disease State	HIV/AIDS #3 Disease State
Infertility	Infertility #1 Disease State	Infertility #2 Disease State	Infertility #3 Disease State
Immune disorders such as hemophilia	Immune disorders such as hemophilia #1 Disease State	Immune disorders such as hemophilia #2 Disease State	Immune disorders such as hemophilia #3 Disease State
Rare genetic diseases such as Fabray, Tay Sachs, etc.	Rare genetic diseases such as Fabray, Tay Sachs, etc. #1 Disease State	Rare genetic diseases such as Fabray, Tay Sachs, etc. #2 Disease State	Rare genetic diseases such as Fabray, Tay Sachs, etc. #3 Disease State
Transplant related medications	Transplant related medications #1 Disease State	Transplant related medications #2 Disease State	Transplant related medications #3 Disease State
Vaccines (adult only - i.e. Shingles)	Vaccines (adult only - i.e. Shingles) #1 Disease State	Vaccines (adult only - i.e. Shingles) #2 Disease State	Vaccines (adult only - i.e. Shingles) #3 Disease State
Don't know	Don't know #1 Disease State	Don't know #2 Disease State	Don't know #3 Disease State

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* 19. Rate the level of importance for each of the following in managing your specialty pharmacy benefit costs:

	Very Important	Important	Somewhat Important	Not Important	Don't Know
Direct manufacturer contracting	Direct manufacturer contracting Very Important	Direct manufacturer contracting Important	Direct manufacturer contracting Somewhat Important	Direct manufacturer contracting Not Important	Direct manufacturer contracting Don't Know
Risk sharing contracts	Risk sharing contracts Very Important	Risk sharing contracts Important	Risk sharing contracts Somewhat Important	Risk sharing contracts Not Important	Risk sharing contracts Don't Know
Innovative health plan designs	Innovative health plan designs Very Important	Innovative health plan designs Important	Innovative health plan designs Somewhat Important	Innovative health plan designs Not Important	Innovative health plan designs Don't Know
Alternative risk financing and actuarial design	Alternative risk financing and actuarial design Very Important	Alternative risk financing and actuarial design Important	Alternative risk financing and actuarial design Somewhat Important	Alternative risk financing and actuarial design Not Important	Alternative risk financing and actuarial design Don't Know
Alternative drug delivery channels for access and/or distribution	Alternative drug delivery channels for access and/or distribution Very Important	Alternative drug delivery channels for access and/or distribution Important	Alternative drug delivery channels for access and/or distribution Somewhat Important	Alternative drug delivery channels for access and/or distribution Not Important	Alternative drug delivery channels for access and/or distribution Don't Know
Exclusive or limited networks by setting of care	Exclusive or limited networks by setting of care Very Important	Exclusive or limited networks by setting of care Important	Exclusive or limited networks by setting of care Somewhat Important	Exclusive or limited networks by setting of care Not Important	Exclusive or limited networks by setting of care Don't Know
Improved contracting (terms and coverage for claims reimbursement)	Improved contracting (terms and coverage for claims reimbursement) Very Important	Improved contracting (terms and coverage for claims reimbursement) Important	Improved contracting (terms and coverage for claims reimbursement) Somewhat Important	Improved contracting (terms and coverage for claims reimbursement) Not Important	Improved contracting (terms and coverage for claims reimbursement) Don't Know
Better coordinated information on disease therapies	Better coordinated information on disease therapies Very Important	Better coordinated information on disease therapies Important	Better coordinated information on disease therapies Somewhat Important	Better coordinated information on disease therapies Not Important	Better coordinated information on disease therapies Don't Know
Incorporation of wellness strategies across the continuum of patient care	Incorporation of wellness strategies across the continuum of patient care Very Important	Incorporation of wellness strategies across the continuum of patient care Important	Incorporation of wellness strategies across the continuum of patient care Somewhat Important	Incorporation of wellness strategies across the continuum of patient care Not Important	Incorporation of wellness strategies across the continuum of patient care Don't Know

Benefit Plan Design

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* 20. Rate the level of importance for each of the following in managing your specialty pharmacy benefits:

	Very Important	Important	Somewhat Important	Not Important
Managing costs	Managing costs Very Important	Managing costs Important	Managing costs Somewhat Important	Managing costs Not Important
Reducing inappropriate utilization	Reducing inappropriate utilization Very Important	Reducing inappropriate utilization Important	Reducing inappropriate utilization Somewhat Important	Reducing inappropriate utilization Not Important
Improving accuracy in the pharmacy and medical plan design	Improving accuracy in the pharmacy and medical plan design Very Important	Improving accuracy in the pharmacy and medical plan design Important	Improving accuracy in the pharmacy and medical plan design Somewhat Important	Improving accuracy in the pharmacy and medical plan design Not Important
Improving adherence/compliance	Improving adherence/compliance Very Important	Improving adherence/compliance Important	Improving adherence/compliance Somewhat Important	Improving adherence/compliance Not Important
Improving quality of life	Improving quality of life Very Important	Improving quality of life Important	Improving quality of life Somewhat Important	Improving quality of life Not Important

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* 21. Which best describes your current specialty pharmacy plan design? (check all that apply)

Same as traditional pharmacy design using tiers and co-pays

Same as traditional pharmacy design using tiers and co-insurance

Special tier with co-pays

Special tier with co-insurance

Don't know

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* 22. What other components are included as part of your current specialty pharmacy plan design? (check all that apply, but no more than 5)

Special distribution requirements

Required use of a specialty pharmacy

Patient support and case management

Prior authorization for medical claims approval

Prior authorization for pharmacy claims approval

Preferred products/formulary for some drugs

Restricted coverage under the medical benefit

Step therapy edits for claims approval

Other, please specify

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* 23. Rank the following tactics for managing specialty pharmacy benefits in order of priority (e.g. 1 to 7 - #1 = top priority):

Case management

Drug utilization

Cost sharing

Prior authorization

Practice guidelines

Combining medical and pharmacy data

Quantity approaches

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* 24. Indicate any additional tactics that should be included in above list and provide order of placement (e.g. if new tactic prioritizes before #4 in above list - list as 3B below):

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* 25. Indicate how the following tactics could impact the productivity of at-risk patients:

	Highly improve	Improve	Somewhat improve	Does not improve
Case management	Case management Highly improve	Case management Improve	Case management Somewhat improve	Case management Does not improve
Drug utilization	Drug utilization Highly improve	Drug utilization Improve	Drug utilization Somewhat improve	Drug utilization Does not improve
Cost sharing	Cost sharing Highly improve	Cost sharing Improve	Cost sharing Somewhat improve	Cost sharing Does not improve
Prior authorization	Prior authorization Highly improve	Prior authorization Improve	Prior authorization Somewhat improve	Prior authorization Does not improve
Practice guidelines	Practice guidelines Highly improve	Practice guidelines Improve	Practice guidelines Somewhat improve	Practice guidelines Does not improve
Combing medical and pharmacy data	Combing medical and pharmacy data Highly improve	Combing medical and pharmacy data Improve	Combing medical and pharmacy data Somewhat improve	Combing medical and pharmacy data Does not improve
Quantity approaches	Quantity approaches Highly improve	Quantity approaches Improve	Quantity approaches Somewhat improve	Quantity approaches Does not improve

Other (please specify)

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* 26. What is the minimum out-of-pocket cost per specialty pharmacy fill for your covered population?

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* 27. What is the maximum out-of-pocket cost per specialty pharmacy fill for your covered population?

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* 28. If you offer incentives, such as waiver of co-pays/co-insurance for your covered population, which of the following actions do you encourage them to take?

	Yes	No	Don't know
Using a specialty pharmacy	Using a specialty pharmacy Yes	Using a specialty pharmacy No	Using a specialty pharmacy Don't know
Receiving higher value medications at a lower cost share	Receiving higher value medications at a lower cost share Yes	Receiving higher value medications at a lower cost share No	Receiving higher value medications at a lower cost share Don't know
Participating in case or disease management	Participating in case or disease management Yes	Participating in case or disease management No	Participating in case or disease management Don't know
Adhering to medications	Adhering to medications Yes	Adhering to medications No	Adhering to medications Don't know
Complying to medical therapy program	Complying to medical therapy program Yes	Complying to medical therapy program No	Complying to medical therapy program Don't know

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* 29. In order to receive coverage, do you require that your covered population use an in-network specialty pharmacy?

Yes

Don't know

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* 30. (Only answer if "yes" to #29) Do you allow a specific number of fills at the retail pharmacy before the use of specialty pharmacy is required?

Yes

Don't know

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* 31. (Only answer if "yes" to #30) How many fills are allowed at the retail pharmacy before the use of specialty pharmacy is required?

One

Two

Three

Four

Five or more

Don't know

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* 32. What type of network do you use for specialty pharmacy drugs? (check all that apply)

Open pharmacy network

Limited pharmacy network

Open specialty pharmacy network only

Health plan or PBM specialty pharmacy network only

Don't know

Other, please specify