Drugs Where do we begin?

Drugs Where do we begin?

Pharmacy spend continues to be a hot topic for employer groups as they attempt to flatten the cost trends, but specialty medication costs seem to be winning most battles!  As an employer, you may ask yourself, “What can we do?”  How many more tiers must we add to manage our costs, which shifts costs to the backs of our employees? 

Many groups are continuing to feel the pain of increased pharmacy use and trend, so much that it is now costing them in their stop loss reinsurance bucket, as well.  Budgeting for $100,000 medications is not in the cards for many employers; therefore, they need to purchase additional insurance – on top of increasing spend – to mitigate their risk.

It’s a double whammy!  If you have maximized contract terms and implemented the most aggressive mail order or 90-day incentives, then here are a few other considerations:

  1. Biosimilars are making their way to the market, but they are being prescribed at a slow rate.  These drugs will hopefully replace heavily prescribed specialty medications, such as Humira, Enbrel and many others.  Get in front of this curve, and work with your pharmacy benefit manager to learn more about this solution and how it can be incorporated into your plan design.
  2. Dive into the cost of care at various sites (outpatient, physician, home infusion, various ambulatory infusion centers, etc.). The cost to administer the same drug at these locations can vary. Ask your pharmacy benefit manager (PBM) what they are doing to steer members to the right site of care to minimize costs, while maintaining a consistent level of outcome
  3. Ask your PBM about considering a high performance formulary within your plan. Evaluate the plan disruption, create appropriate employee education, and help explain why a change like this is necessary to continue to offer a cost effective benefit package to employees.

At the end of the day, more employee education around options will help us ride the current wave of pharmacy spend, while avoiding a complete wipeout!

Meet the Author

Matt Cole

Matt Cole brings a wealth of experience and knowledge within the Health and Benefits industry.  He was most recently the Manager of New Business Sales and Growth for Blue Cross Blue Shield of Michigan and also served in a variety of roles within Aon Hewitt – one of the nation’s largest Health and Welfare consulting practices. Matt focuses on market trends, carrier contracting, network and product evolution, and optimization of benefit plans.  He specializes in working with customers to create and identify long-term strategies  that are both competitive and comprehensive by design.


About the Author


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