OBJECTIVES: To evaluate employer perspectives on alternative funding programs (AFPs), which often controversially tap into other sources (e.g., advocacy groups, foundations, or grants) to pay for patients’ medication costs.

METHODS: A national web-based survey of US employer drug benefit decision-makers was fielded in February 2023.

RESULTS: A total of 50 self-insured employers, with 2,000 or more employees, participated in the survey. 62% of survey respondents rated the cost of specialty medications as very or extremely concerning for their organizations. Almost all respondents (92%) agreed that medication costs were prompting employers to consider services they would normally avoid. Maintaining patient access to medications was a priority when making specialty pharmacy benefits decisions, with 92% of survey respondents saying patient access to medications was a factor of high importance. While 76% of survey respondents had not implemented an AFP, 26% were considering it. 64% of survey respondents did not have a clear understanding of how AFPs differed from specialty medication management programs like copay accumulators or copay maximizers. 40% agreed that AFPs provide value to employers looking to control specialty pharmacy costs compared to 60% who had a neutral response. 68% percent considered it highly to moderately problematic if AFPs diverted resources from underinsured or uninsured patients.

CONCLUSIONS: The high cost of specialty medications and a desire to sustain patient treatment access are prompting respondents to search for solutions they normally would not consider. This tension between trying to control pharmacy costs while still offering patients access to medications may fuel employer interest in AFPs, although most have not yet implemented the programs. Employer understanding of how the programs operate and differ from other specialty medication management programs is limited. Most survey respondents took a neutral stance on AFPs but recognized that aspects like diverting resources from under-insured patients can be problematic.