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networks," says Steve Wojcik, Vice President of P ubl ic Pol ic y at N BGH . " Employers a re a lso increasingly interested in accountable ca re orga n i zat ion s, med ica l homes a nd ot her t y pes of a lternative deliver y a rra ngements that promise to increase ca re coordination, reduce costs a nd improve qua lit y a nd outcomes." Approximately 43 percent of employers are considering shifting to a high-performa nce network, according to P wC. RISING COSTS, BUT MORE COMPETITION A lthough specia lty drugs have long been a driver of high hea lthcare costs, the Large Employers' 2017 Hea lth Plan Design Sur vey from the NBGH revea led that, for the f irst time, spending on specia lty pha rmaceutica ls is the most-cited factor in increasing medica l costs. However, ma ny employers a re using progra ms to mitigate the cost of specia lt y drugs, including: + More agg ressive ma nagement protocols for use of such drugs + Requirements that specia lty medications be obta ined through specia lt y pha rmacists + I mplement at ion of a speci a lt y t ier w it h i n t he ph a r m a c y pla n desig n A dd it iona l ly, pha r m a c y benef it m a na gers a re t u r n i n g t o agg ressive tactics to drive down the costs of specia lt y drugs. " Thir t y percent of our clients experienced either no increase or a decrease in their spending on prescription medications in 2015," says Heather Sunda r, Pha rmD, Vice President of Clinica l Prog ra ms at Ex press Scr ipts, t he nation's la rgest pha r macy benef it ma nager. "Our nationa l preferred formula r y is desig ned to create competition within therapy classes, a nd that 's how we deliver significant savings for payers. Payers who use the preferred formula r y will save $5 billion between 2014 a nd 2017, with ver y minima l patient or physicia n disruption." ■ Better Access to Behavioral Health Care, at a Cost A LTHOUGH ONE IN FI V E Americans has an addiction or mental illness, mental health has often taken a back seat in terms of health sta- tus and spending. However, access to mental healthcare services is quickly achieving parity with physical health care. Policy changes, such as the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and the ACA, have strengthened par- ity requirements for employer-sponsored health plans. In 2016, an interagency task force on mental health parity conducted public forums with consumers, families, providers, insurers and state insurance commissioners to determine how best to ensure patients are not excluded from behavioral health services. As systems to access mental health care become more effi cient and utilization for these services increases, the share of employer health spending on mental health care is expected to increase. Many employers are also exploring innovative ways to increase access to and quality of mental health services. Nearly all large employers surveyed by the National Business Group on Health offered an employee assistance program for behavioral health, including educational resources and assessment and other ser- vices for managing emotional and substance use issues, interpersonal relationships, legal problems, and fi nancial diffi culties. More than half of large employers offered self-help electronic resources. More than a third offered behavioral health via telehealth, and 8 percent offered computer- based cognitive behavioral therapy. 1 1 M D N E W S .C O M /// M D N E W S C L E V E L A N D /A K R O N / C A N T O N ■ J A N U A R Y/ F E B R U A R Y 2 017