Regaining Control Amidst the Uncertainty of 2022 Pharmacy Benefits Planning

Top 3 Things You’ll Learn

  1. Major areas of uncertainty within the member population as we approach 2022
  2. Challenges employers face as they manage costs and protect employee health
  3. The value of a data-driven vs. a wait-and-see approach for pharmacy benefits decision-making

There will always be some level of uncertainty when a thoughtful HR team is planning for the next benefit year.  Typical questions include: What new diagnoses will there be within our member population? What kinds of new specialty drugs are coming to the market, and how do we mitigate costs for existing high-cost claimants? How many and how often will I see new specialty drugs in my pharmacy claims file? Are there lower net cost options, and will they work as well? Will RSV and flu season be severe this year? How do we keep our teammates healthy?  These are big questions that HR leaders have to address every year, and 2020-2021 definitely 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.  As we approach 2022, employers are still having difficulty re-recruiting workers back to the workforce.

The Uncertain World Employers Face

We’ve known that the pharmacy portion of the overall healthcare spend is growing as prescription drug costs continue rising year over year. the drug pipeline is stacked with innovative brand and specialty drugs, and the high costs associated with these “miracle” drugs impact the ability to afford the medications. In fact, the average wholesale price (AWP) of medications has been growing at a rate of 6% annually, while one in five people reported they were unable to afford the cost of their medications. COVID has created some interesting trends as well – since March 2020, fewer new prescriptions for acute conditions were written while 90-day supply prescriptions for chronic conditions increased, including medications for diabetes and blood pressure, and high cholesterol. Additionally, fewer elective procedures took place over the last 18 months. Due to safety precautions like masks, handwashing, and social distancing, the previous flu season was much less severe than those in recent years. While some of these trends are expected to return to what we saw before March, others are expected to stick.

Employers today need to ensure that employees have access to medications, vaccines, and wellness programs as offices reopen. As mentioned above, the difficulty in recruiting new and returning talent in today’s climate is a real struggle for some employers, and attractive benefits packages have become a cornerstone of their recruitment efforts. What will the new normal look like for employers in late 2021 and beyond? Can we, as a culture, sustain a productive blend of in-office and work-from-home practices?  Will we be able to remain healthy as the next flu season closes in?  How will employers handle flu shot clinics with so many teammates working remotely?

Self-funded employers have a few options. They can:

  • Take a wait-and-see approach and do nothing,
  • Guess how their plan will be impacted.
  • Use data to inform their decision-making.

This third option means that instead of giving in to the sense of “no control,” HR leaders and decision-makers can act now to find certainty in these uncertain times with the right benefit partners.

Many employers have taken a wait-and-see approach to their pharmacy benefits planning. 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

Per 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 determine whether the existing market forces that are plaguing so many employers are impacting them, and the options they have now to rectify any potential risks 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, and 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, self-funded employer groups 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 impacting self-funded pharmacy benefits plans and how to put your clients in control of decision-making.

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