Improvement & Learning Collaboratives

CQC’s improvement and learning collaboratives are multi-year programs offering technical assistance. Program participants receive personalized coaching from experts and engage in educational opportunities including virtual peer sharing, site visits and data analytics. These programs aim to foster a sustainable health care system accessible to all.

CalHIVE Behavioral Health Integration

(more…)

EmployersRx 2022 Policy Agenda

Our goal: Support Policies to Reduce Costs for All Purchasers While Encouraging Meaningful Innovation

End patent gaming. Support efforts to end gaming of patent and market exclusivity laws by drug makers.

• Eliminate “evergreening” and other “patent thickets” to ensure that branded products will face competition from generic drugs and biosimilars in line with the intent of current laws.
• Prevent first-to-file generic drug applicants from blocking, beyond a 180-day exclusivity period, the entrance of subsequent generic drugs to the market.
• Reduce citizens petition abuse by giving the FDA additional guidance on denying petitions submitted for the purpose of delaying generic approval.
• Require branded biologic companies to publicly list drug patents they can reasonably defend.

Transform the drug supply chain to ensure transparency and fair prices. Advocate for policies to bring fundamental change to the opaque and distorted drug supply chain.

• Continue to support policies designed to bring transparency to the drug supply chain, including requirements the Consolidated Appropriations Act of 2020 and the Transparency in Coverage rule placed on PBMs and others in the supply chain.
• Support new requirements for end-to-end price transparency placed directly on Pharmacy Benefit Managers (PBMs) and like organizations.
• Advocate for a comprehensive federal investigation of the drug supply chain, to include the financial and ownership relationships between PBMs; health insurers, group purchasing organizations; in-person pharmacies; mail-order specialty pharmacies; and affiliated organizations, including those based overseas.
• Establish a clear regulatory framework for PBMs and other organizations in the drug supply chain. This should include consideration of extending ERISA fiduciary responsibility to PBMs and affiliated organizations so that such entities are required to act in the best interest of plan sponsors and beneficiaries.

Support common-sense price transparency requirements for drugs sold to commercial employers.

• Require drug manufacturers to publicly report and explain price increases that exceed certain thresholds.
• Require health care providers and pharmacies to include National Drug Codes (NDC) in claims for commercial health plans. NDC codes are currently required for claims to public payers (Medicare and Medicaid) and provide greater transparency on prices to purchasers.

Oppose policies limiting purchasers’ ability to manage drug costs.
Other stakeholders have proposed policies that would limit the ability of employers and purchasers to manage their drug costs. These policies would further drive-up health costs for purchasers and families, and have no basis in clinical efficacy. EmployersRx will strongly oppose these policies which strip employers and purchasers of their already limited ability to manage their drug costs.

Support policies to catalyze the development and use of lower-priced biosimilars.
Employers and purchasers support the use of lower-priced biosimilar products. However, we do not support policies that further entrench the misguided Medicare Part B drug payment policy, which pays physicians to administer drugs based on their price.

Develop policies to address the very high cost of new specialty drugs.
Many new specialty drugs on the market or in development hold significant promise in the treatment or even cure of debilitating diseases. However, these drugs come with large price tags, significantly affecting employer drug spending. Policymakers should investigate and develop policies to address the very high cost of these drugs. Policies should focus on ensuring reasonable payment for highly effective therapies, while avoiding simply shifting how high-cost drugs are paid for, such as “drug mortgages” or other similar mechanisms.

Support comparative effectiveness research.
Support establishment and/or federal certification of independent comparative effectiveness entity/entities. Academic and empirical evidence demonstrates that drug prices are not meaningfully tied to the effectiveness of drugs in treating, curing, or managing disease. Private payers need this vital information to price drugs effectively. Prescription drug comparative effectiveness entities could be publicly operated, quasi-governmental, or non-profit, but must remain independent of manufacturers, health plans, PBMs, and other financially interested parties.

Continue to support fairness for private health plans in Medicare negotiation and inflation caps.
Continue to support inclusion of protections for private health plans in legislation enabling Medicare to negotiate the price of high-cost drugs and establish inflation caps on sole source drugs.

EmployersRx 2021 Policy Agenda

Support Policies to Reduce Costs for All Purchasers While Preserving Meaningful Innovation

Policymakers are considering a set of policies that use the Federal Government’s purchasing power to meaningfully reduce drug prices for beneficiaries and taxpayers. To ensure that these policies do not result in cost shifting to private payers, and to provide direct relief to families covered by private insurance, it is essential that any policies to directly manage drug prices extend to all payers, not just public programs. To that end, we urge policymakers to:

• Allow the federal government to enter into meaningful negotiations on the certain costs of drugs that lack sufficient competition. Negotiated prices must be available to all drug purchasers, not just Medicare. Negotiated prices should align with clinical efficacy, consider the price of the drug in other industrialized countries,and protect true innovation.
• Cap price inflation on existing drugs. The inflation cap must apply to all payers.
• Modify Medicare Part B to eliminate the incentive for providers to prescribe higher cost drugs.

Support Policies to Strengthen Competition and Enhance Transparency

Policymakers can take steps to indirectly reduce the cost of drugs by banning anticompetitive practices by drug makers and other actors, and enhancing price transparency. To that end, we urge policymakers to:

• Eliminate “patent evergreening” and other “patent thickets” to ensure that branded products will face competition from generic drugs and biosimilars in line with the intent of current laws.
• Prevent first-to-file generic drug applicants from blocking, beyond a 180-day exclusivity period, the entrance of subsequent generic drugs to the market.
• Reduce citizens petition abuse by giving the FDA additional guidance on denying petitions submitted for the purpose of delaying generic approval.
• Require drug manufacturers to publicly report and explain price increases that exceed certain thresholds.
• Require branded biologic companies to publicly list drug patents they can reasonably defend.
• Require health care providers and pharmacies to include National Drug Codes (NDC) in claims for commercial health plans. NDC codes are currently required for claims to public payers (Medicare and Medicaid) and provide greater transparency on prices to purchasers.
• Require complete transparency by pharmacy benefit managers and the pass through of all rebates and related fees and payments to plan sponsors.
• Address spread pricing by pharmacy benefit managers, health plans, providers, and other intermediaries. Purhasers should be given the option to accept or reject spread pricing. This policy should apply to drugs administered directly by providers and sold in the pharmacy setting.

Oppose Policies Limiting Purchasers’ Ability to Manage Drug Costs

Other stakeholders have proposed policies that would limit the ability of employers and purchasers to manage their drug costs including banning step therapy and generic substitution. These policies would further drive up health costs for purchasers and families, and have no basis in clinical efficacy. EmployersRx will strongly oppose these policies which strip employers and purchasers of their already limited ability to manage their drug costs

State Policy Solutions

Effective markets require healthy competition and transparent information on cost and quality. Unfortunately, these conditions don’t exist in all health care markets. Entrenched interests feed off market failures and use their political muscle to keep the broken status quo in place. If we’re going to rely on competitive market forces to keep prices reasonable, government must step in to make sure that markets are working the way they should. In some areas, however, the market is fundamentally broken, and it is nearly impossible to address costs through competition. In these situations, government needs to step in to limit prices.

As the leading voice of large national employer health care purchasers on public policy, PBGH has a track record of advocating for a market environment of healthy competition and successfully influencing both state and federal policy to enhance, among other priorities, value-based purchasing and the restriction of anti-competitive practices ​in order to improve affordability and quality.