Top 3 Pharmacy Benefit Design Strategies for 2020

Top 3 Things You’ll Learn

  1. Projected healthcare benefits costs per employee in 2020
  2. How to protect your clients’ prescription drug program against unnecessary spending
  3. Why a carved-in benefits model limits your ability to lower pharmacy costs for your clients

The total cost of employer health benefits is expected to rise 5% this year with cost management initiatives taken into account, according to the National Business Group on Health’s (NBGH) 2020 Large Employers’ Health Care Strategy and Plan Design Survey. The survey also revealed that the total cost of health care is estimated to be $15,375 per employee, including premiums and out-of-pocket costs for employees and dependents.

Total cost of health benefits could rise 5% this year. Top management strategies include greater oversight of high-cost prescription drugs. #drugcosts

Here are three way you can help your clients curb their healthcare benefits costs. This list features some of the top strategies that employers surveyed plan to implement or continue this year:

  • Focusing on prescription drug benefits – Prescription drugs have gradually been taking over as the most expensive part of employee health care benefits, which is likely seen as increases to the medical benefits, especially when pharmacy and medical are bundled under the same contract. To effectively manage the specific cost drivers impacting your clients’ bottom line, you need to zero in on the pharmacy benefits. The most effective way to do that is to carve-out the prescription drug plan from the medical carrier and work directly with a pharmacy benefit provider who exclusively focuses on managing prescription drugs. Choosing to stay carved-in will pose a greater challenge in effectively identifying and addressing the pharmacy-related factors driving your clients’ health care costs.
  • Zeroing in on high-cost claims – With more expensive prescription medications coming to market each year, it’s no surprise that managing high-cost drugs remains a major priority for employers. Brand-name and specialty medications still account for almost 50% of drug spend while accounting for less than 2% of claims. Through the pharmacy benefit manager (PBM) or pharmacy benefit optimizer (PBO), your clients can access valuable programs and tools that provide protection against unnecessary plan spending on high-cost drugs.
  • More virtual care solutions –As the use of technology expands, consumers are demanding more immediate service to address their healthcare needs. They want greater access to their providers and immediate answers to their concerns, and they want it available at their fingertips. This trend is influencing employee service models and points to the need for new, virtual care solutions. You will need to help your clients meet this demand by showing your employee members that service – in both an in-person and on-demand format – is a top priority.

See how this data compares to the previous survey that revealed the top benefit design strategies employers planned to use in 2019.

For more information on how high-cost medications are impacting pharmacy benefits, check out our e-book, How to Successfully Navigate Troubled Waters.


Business Group on Health

Share It

Enjoy our latest blogs, white papers and news by signing up for our newsletter today!