Five Rights Framework Seeks to Improve Dysfunction in Specialty Drug Marketplace


Newly developed framework offers a common ground for specialty pharmacy stakeholders.

The National Alliance of Healthcare Purchases Coalitions has released stakeholder guidelines and an engagement framework to improve the specialty drug marketplace, according to a press release.

The guidelines were created in an effort to drive collaboration to control costs, reduce waste, and optimize the efficacy of specialty medications, according to the release.

“Specialty drugs are the fasted growing area of spend for employers today,” Mike Thompson, National Alliance president and CEO, said in a release. “While these new drugs are truly innovative and important, the specialty drug marketplace itself is dysfunctional with high-cost, high variation, and high waste. We need to collaborate with stakeholders to wring out the costs of poor quality and unwarranted cost, complexity and conflicts.”

The Five Rights framework was designed to raise purchaser expectations for industry stakeholders to improve understanding and better evaluate and improve the specialty drug marketplace.

The framework targets critical issues and opportunities for specialty stakeholders, which included manufacturers, health plans, pharmacy benefit managers, and providers. It also outlines key areas for each stakeholder to improve.

The National Alliance collaborated with several purchaser-led member coalitions, including the Minnesota Health Action Group, Midwest Business Group on Health, and the Florida Health Care Coalition, to develop the framework. The information is currently being shared with purchaser coalitions across the country, according to the release.

“Vendor contracting should be based on full transparency and accountability to eliminate waste, reduce the impact of middlemen, mitigate costs, and lead to overall improved plan performance and member health,” Cheryl Larson, vice president of Midwest Business Group on Health, said in a release. “We’ve established these rules of engagement to assist employers to raise the bar.”

The Five Rights framework includes: basing practices and decisions on clinical safety and efficacy independent of conflicted interests; covering testing that supports improved assessment of correct drug, dose, and duration of treatment for specific patients; and requiring purchaser transparency and engagement on key issues and National Drug Codes used by all providers in all settings.

“After 2 years of intensive study, Action Group members developed this framework to offer a common ground for all stakeholders,” Carolyn Pare, president and CEO of the Minnesota Health Action Group and developer of the initial Five Rights, said in a release. “Offering a road map for the Right Drug, Right Price, Right Place, Right Support, and Right Data, this framework provides insights for each stakeholder to do their part to deliver on that promise.”

The following are additional highlights of The Five Rights framework:

· Align value-based contracting with performance and adherence to high-value drugs with correct dose and duration consistent with guidelines.

· Require cost parity or benefits differentials across sites of care for same drugs and services.

· Support patients on drug administration and needed emotional and social support to increase adherence and improve outcomes.

· Discontinue consumer coupon programs that encourage use of low-value, high-cost drugs in place of therapeutically equivalent.

“As purchasers and purchaser coalitions, we play a critical role to help rationalize the specialty drug marketplace,” Karen van Caulil, president and CEO of the Florida Health Care Coalition and National Alliance board chair. “When we act together and are open to disruptive innovation, we can change the system for the better.”

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