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Your company has seen a significant rise in its costs of providing health care benefits, and in particular the cost of prescription drug benefits. What are some of the things a company can do to contain some of these costs? |
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Answer: |
More employers are taking a multi-pronged approach to manage prescription drug costs, according to Towers Perrin HR Services. In a recent Perspective, Towers Perrin reviewed some of these strategies, their targets, and their potential results.
Align pharmacy benefit management (PBM) incentives with employer cost control objectives. To reduce PBM plan administrative fees, "questionable" pricing practices, and drug-maker rebates that cost group health plans more, employers stipulate specific financial and contract protections, including pricing transparency (full disclosure of PBM revenue sources); 100 percent pass-through to plan sponsor of rebates, discounts, and dispensing fees; and greater access to PBM information for audits.
Plan design involves employee choices. Employers are adding coverage tiers, deductibles, and coinsurance levels that make members more cost-conscious and discriminating purchasers.
Manage specialty drug dispensing. Employers are targeting expensive injectable and biotech drugs for chronic diseases and determining the most cost-effective delivery channel, implementing benefit design specific to specialty drugs, using care and utilization management, and adding lifetime limits for drug coverage.
Integrate drugs into total medical care management. Employers are tracking together the use of all medical services, including office visits, hospital stays, and laboratory tests to obtain a total view of the care trend and allow better care management. These types of programs can identify care gaps and notify physicians of problems. In more than half of cases, the physician will change patients' medications, Towers Perrin found.
Worksite pharmacies. Another strategy that employers are using to reduce escalating drug costs is onsite or worksite pharmacies, according to an article in the July 15 issue of Drug Benefit News. Some independent companies specialize in providing these types of pharmacy services. The worksite pharmacy providers state that they can provide prescription drugs at a substantial savings that cannot be realized through retail networks. The worksite pharmacies emphasize cost savings measures such as generic substitution, tablet splitting, coordination of therapies with other medical providers including PBMs, and patient education.
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