Regain Control Amidst the Uncertainty of 2021 Pharmacy Benefits Planning

Top 3 Things You’ll Learn

  1. Major pharmacy industry trends impacting self-funded employers in 2020
  2. Challenges employers face as they manage costs and protect employee health
  3. Using a data-driven vs wait-and-see approach for pharmacy benefits decision-making

Any year in pharmacy, there’s going to be some uncertainty and some unknowns. Typical questions would be, what new diagnoses will there be in a member population? What new specialty drugs are coming to the market? How many and how often will I see it in my pharmacy claims file? Are there low net cost options? Will RSV and flu season be bad this year? All of these are big questions we have every year, but 2020 has raised the bar on uncertainty. The global pandemic has caused economic strife, job loss, stress and anxiety, mental health concerns – and employers are under enormous strain.

The Uncertain World Employers Face

Pre-COVID-19, we already knew that prescription drugs costs were increasing, the drug pipeline is stacked with innovative brand and specialty drugs, and the high-costs associated with those drugs were impacting peoples’ ability to afford their medications. In fact, the average wholesale price (AWP) of medications was growing at a rate of 6% annually, while one in five people reported they were unable to afford the cost of their medications. Add to that the new trends created by COVID-19 since March 2020. For one, we saw fewer prescriptions for acute conditions and more prescriptions for chronic conditions, including diabetes, blood pressure, and other medications that require daily dosing. There also was a shift to 90-day mail-order prescriptions and fewer elective procedures taking place – all the while drug manufacturers continued to increase drug prices. While some of these trends are expected to return to what we saw before March, others are expected to stick.

As most states re-open and people go back to work, employers now are thinking about how to bring their employees back safely. They need to ensure that employees have access to medications, vaccines, and wellness programs. Additionally, as hospitals and doctors offices resume elective procedures, there is sure to be a shift back to increased utilization of acute condition drugs and medical costs. All of that said, the looming question is, what is the new normal going to look like for employers? All of these factors put together create an uncomfortable sense of uncertainty.

Self-funded employers have a few options: they can take a wait-and-see approach and do nothing, they can guess at how their plan will be impacted, or they can use data to inform their decision-making. This third option means that instead of giving in to the sense of no control, you can act now to help your clients find certainty in these uncertain times.

Many employers have taken a wait-and-see approach to 2021 pharmacy benefits. The only way to know you’re making the best choice for your Rx plan and your employees is with a data-driven analysis of your specific risk areas.

Using Data to Take Back Control

In the wise words of Benjamin Franklin, if you fail to prepare, you are preparing to fail. Just as you would plan your household budget, the same basic principles apply in planning your clients’ pharmacy benefits budgets. It’s impossible to plan for the future if you have no idea what your expenses and risk areas are. By evaluating your clients’ current pharmacy plan performance, you can find out for sure whether they are being impacted by the existing market forces that are plaguing so many employers, and what options they have now to rectify any potential risk areas before it’s too late.

The best place to start is by looking at their current pharmacy claims data to review pricing and clinical performance, determine the level of risk, and member impact. This type of comprehensive pharmacy performance analysis will provide you with the insight necessary to help your clients prepare for the future – by providing them with tailored options that address their known risk factors and setting a foundation for the unknown expenses to come. With greater clarity around their pharmacy plan performance, your clients will be armed with the tools they need to make informed decisions that are in the best interest of their plan and employees.

Watch our on-demand webinar, Overcoming Uncertainty, or download our ebook, Definitive Guide to Optimizing Pharmacy Benefits, to learn more about the market factors impact self-funded pharmacy benefits plans and how to put your clients in control of decision-making.

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