Pharmacy Benefits Cost Implications of COVID-19 Treatments and Vaccines

Top 3 Things You’ll Learn

  • Top pharmacy benefits trends resulting from the COVID-19 pandemic
  • Costs that employers can expect to incur as employees return to work
  • How to help your employer clients prepare now for new treatments and vaccines

COVID-19 is on everybody’s mind. It changed the way that many of us work and interact with other people on a daily basis. In managing a prescription drug benefit, there is potential for employers to see an impact. No one knows with great certainty how to estimate that impact, but here are a few things that we know and some things we’ll have to keep an eye on as things unfold:

Increase in chronic condition prescriptions – We have seen some decrease in prescriptions for acute medications that you might normally get for the common cold or aches and pains, and we are seeing a disproportionate amount of chronic medications – more than we have seen in the past. That is likely to be a short-term phenomenon caused by the pandemic. As the world moves into the next several months and beyond, we’ll probably expect the number of prescriptions for acute conditions tick back up.

Shift from 30-day to 90-day prescription fills – We’ve also seen people shift from taking 30-day fills of their prescription drugs to getting 90-day fills. This trend will probably continue as we move forward because once people make that shift, they are more likely to stay with it. Most of the pharmacy benefits managers (PBMs) have relaxed their refill-too-soon policies temporarily, as they make sure people have access to their medications. It’s appropriate, as things begin to resolve, to expect a shift back to 70%-80% refill rates so that people cannot stockpile medications. For example, with a 70% refill rate for a 90-day prescription, people will need to wait until day 63 to refill their medication, which is appropriate.

Existing therapies used to treat COVID-19 – As far as the therapies that are on the market today being used to try to treat COVID-19, production will ramp up over time and we’ll see plenty of that medication available in the pipeline. As prescribers look to use those medications in larger populations, we expect there to be a more ample supply of treatment, especially if we experience a second wave of infections. If those are inexpensive medications, we won’t expect those to move the needle very much.

New COVID-19 treatments and vaccines – What’s more likely to move the needle are some of the newer therapies that are being explored right now. As those come to the market, it’s unclear exactly what they’ll cost. We’re going to have to stay tuned to that. As vaccines are developed, that is another expense that employers will have to prepare for – one that has not previously been incurred. Whether the vaccines take place in the medical side or the pharmacy side, we’ll have to see.

The impact of COVID-19 can be felt across industries and will grow as newer therapies and vaccines are developed, says Mark Campbell, PharmD of @RxBenefits.

What Employers Can Do Now

As part of a comprehensive approach to managing employee health, your clients will be looking for new workplace procedures and programs that help them ensure the safety and wellbeing of their employees, especially those returning to work for the first time. It will be important that they consider changing (or implementing) plan design incentives that encourage their employees to participate in regular health screenings and get vaccines.

It will be equally as important to include independent prescription drug oversight in that discussion. Having clinical programs in place to manage appropriate utilization enables your clients to be better positioned to provide their employees and members with the most clinically effective, lowest cost medications available. This type of clinical oversight will help them manage and reduce their pharmacy benefits spending, freeing up valuable dollars they can use to implement those new health screening measures. Being prepared and implementing changes now will prove to be a critical step for employers in maintaining a healthy workforce and their long-term productivity.

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