SIIA Releases Drug Pricing Best Practice Guide

The SIIA Drug Price Task Force, including BCS Chief Actuary and MRM President Mehb Khoja, has released its Best Practices to Help Manage High-Cost Pharmaceuticals. Read the full press release from the Self-Insurance Institute of America (SIIA) below.

April 1, 2022 – Released this morning as part of the Self-Insurance Institute of America, Inc. (SIIA) Spring Forum, “Managing High-Cost Pharmaceuticals: Self-Insurance Industry Best Practice Guidance” is a new comprehensive guide focused on best practices for managing high-cost drugs in excess of $250,000. The complete Drug Price Best Practice Guide is available to SIIA members here.

The SIIA Drug Price Best Practice Guide was developed by the SIIA High-Cost Drug Task Force. This Task Force is comprised of a diverse group of stakeholders, including brokers, TPA’s, stop-loss carriers, and other industry providers who have been convening regularly since 2020 with the goal of developing a set of best practices to control high-cost drug spend across the self-insured space.

The Guide’s interactive format provides a customizable and navigable document for SIIA members to utilize in considering approaches to best manage high-cost drug spend, while ensuring patients have affordable access to the most effective drug treatments available. Important focus areas of the Best Practice Guide include:

  • Plan Document Guidance: Best practices pertaining to plan document review, prior authorization, steerage, step-therapy and limitations.
  • Roles and Responsibilities: Understanding and mapping the unique and important roles various entities have in reviewing and controlling high-cost drug spend.
  • Financial Considerations: Strategies and opportunities available to better manage financial and health outcomes.

The SIIA Drug Price Best Practice Guide will be reviewed and updated on a periodic basis to provide members with updated and ongoing resources to better manage drug costs.

SIIA would like to thank members of the Drug Price Task Force for their hard work in the development of this important industry resource:

  • Shaun Peterson, Voya
  • Doug Bloomquist, StarLine
  • Stacy Borans, MD, Advanced Medical Strategies
  • Marien Diaz, Symetra
  • Richard Fleder, ELMC Risk Solutions
  • Gerry Gates, Stealth Partner Group
  • Jeff Gavlick, Tokio Marine HCC – Stop Loss Group
  • Raj Gulati, Risk Strategies Company
  • Ken Gumbiner, Berkshire Hathaway Specialty Insurance
  • Steve Kelly, Imagine360
  • Mehb Khoja, Medical Risk Managers
  • Ellen Motolo, Optum
  • Greg Sullivan, HM Insurance
  • Harry Tipper, CaptiveOne Advisors

If you have questions, or would like more information on the Best Practice Guide, please contact Ryan Work at rwork@siia.org.