Economic Downturn and High-Cost Specialty Claims Keep Plan Sponsors Up At Night

With supply chain disruptions, a tight labor market, and financial experts predicting a recession, it is easy to see that the biggest concern for employer-sponsored health plans is affordability. As benefit advisors, the best things you can do to help a plan sponsor protect their budget is to prepare them for an unpredictable specialty medication claim, rein in costs for predictable current members trends, and create a shield with stop-loss insurance.

Adding to employer concerns are drug manufacturers and pharmacy benefit managers protecting their profits from the latest legislative and legal battles, specialty drugs dominating the pipeline, and medication prices increasing yearly. In our latest webinar, I joined RxBenefits pharmacy benefit experts and shared the latest trends impacting your clients in 2023.

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What plan sponsors need to know this year is: Will I pay more or less? Some products and pricing models provide value aligned with that client’s goals, and others add noise and confusion in the pharmacy industry.

To reduce the impact of a catastrophic specialty claim or growing pharmacy spending, a multi-faceted and comprehensive suite of pharmacy benefit solutions is needed.  Humans are unpredictable, and so are their pharmacy benefit claims. An employee could have a child with a serious condition, a member may come home with a rare new diagnosis, or a recently FDA-approved high-cost drug could be the cure for a patient previously thought untreatable — the chances of a specialty claim hitting a plan are greater than ever.  Are your clients prepared for these claims?

Dive into the future of pharmacy benefits. Download our latest State of the Industry eBook.

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