Bundle Design

Bundled payments for episodes of care have proven to be a powerful method for encouraging greater use of high-value health care services and discouraging use of low-value services. Self-insured employers appreciate the predictability of bundled payments because they can budget with greater accuracy.

PBGH develops innovative bundled payment arrangements, approaching these methods as a quality improvement initiative supported by payment reform that can make a measurable difference in patient outcomes and satisfaction.

The Future of Health Coverage Employer-Sponsored Insurance Policy

Despite spending more on health care than any other country in the world, millions of people in the United States lack health care coverage, and millions more can scarcely afford the coverage they have. To solve these difficult challenges, federal policymakers are considering significant changes to current health insurance coverage systems. PBGH is actively engaged in this debate, promoting solutions that both increase access to health care coverage while driving down costs for all purchasers of health care.

Health Equity

Abundant evidence demonstrates that our current health care system produces significant disparities in access to care and care outcomes between racial and ethnic groups. Past efforts to improve health care quality and reduce costs have often ignored — and sometimes even exacerbated — underlying inequities in health. PBGH is committed to identifying and championing health policies that ensure health equity for all people in our country.

Payment Reform and Quality Improvement

Most health care in the United States continues to be purchased in an outmoded and inefficient fee-for-service model, which promotes the overuse of unnecessary, expensive care while ignoring differences in quality. PBGH works with policymakers to advance the development and application of alternative payment models that hold providers accountable for quality of care and promote the use of affordable primary care.

Addressing Consolidation

Anticompetitive practices that stifle employers’ ability to negotiate for the best health care value for their workers has become a growing concern. There is an increase in consolidation leading health systems, insurers and private equity to use their market leverage in ways that cost companies and their workers. What’s more, hospital mergers lead to higher prices, with no evidence of improved quality and with poorer patient experience. PBGH supports both legislative and legal action to reign in market consolidation leading to higher-cost, lower-quality medical care.

Reducing Drug Prices

Over the past decade, the cost of prescription drugs has increased three times faster than the rate of inflation. Prescription drug costs are prohibitive for many consumers and are a leading cause of ever-increasing health care coverage costs. PBGH is focused on reducing the cost of prescription drugs by addressing the underlying drivers of drug costs. We work with policymakers and stakeholders to inject more competition, transparency and value into the health care system.

The Issue

One in four Americans has trouble paying for prescription drugs and four in five believe the cost of drugs is unreasonable. Everyone agrees the system is broken.

Drug manufacturers and middlemen, such as pharmacy benefit managers (PBMs), are gaming the system for profit at the expense of employers, taxpayers and the government. They’ve created a system so complex and convoluted that only they understand it. They use their power to shut out reformers and pad their bottom line. This must end — lives depend on it. That’s why EmployersRx is pressing the U.S. Congress to act now to unrig the system.

Our Mission

Employers’ Prescription for Affordable Drugs aims to mobilize large employers to drive down prescription drug costs by advocating for public policies based on increased competition, transparency and value.

Our Principles

Market Forces
Strengthening market forces is the best way to improve efficiency and quality, but the drug market has several unique characteristics that require public policy intervention to protect consumers.

Business Responsibility
Employers should adopt value-based purchasing strategies to contain drug costs and create programs that model best practices for other companies.

Government Insurance Responsibility
Government-run insurance programs, such as Medicare, must use their bargaining power to help rein in costs for the entire drug market.

System-Wide Costs
Policies to rein in drug costs should address drivers of high drug costs across the system rather than focusing on a single group, such as Medicare, and should not simply shift costs to employers and consumers.

Transparency

Transparency is essential to containing costs since much of the drug supply chain is opaque to consumers due to complex payment arrangements and gag clauses.

Innovation
Government should incentivize innovative drug development and prevent companies from exploiting the system for profit by blocking generics and biosimilars.

Patient Protection
Patients, especially those with serious conditions, should not be faced with excessively high bills to obtain the medications they need to survive.

Coalition Members

COVID-19

The coronavirus pandemic has placed enormous strain on the health care system and purchasers of health care. PBGH advocates for sufficient public health resources to fight the pandemic, economic supports to help the country weather the resulting economic downturn and policies to allow employers and purchasers to continue to provide access to high-quality, affordable health care.