Top 3 Trends in Pharmacy Benefit Design for 2019

Top 3 Things You’ll Learn

  1. How to gain greater insight into high-cost claims
  2. Benefits of copay accumulator protection programs
  3. Why more employers are offering traditional health plan options

Health benefit costs are not slowing down. Despite public outcry and legislative attempts to manage health care spending, costs continue to rise at twice the rate of wage increases and 3x general inflation. Pharmacy accounts for 19% of total health spending, with an average of $116 per member each month. Employees in high-deductible health plans will find medication costs especially concerning as they must pay out-of-pocket until their deductible is met. If you’re an employer reconsidering your plan options, implementing strategies that provide greater visibility can help you see how your pharmacy dollars are being spent.

Top 3 strategies employers used to manage health spend in 2019: focus on high-cost Rx claims, copay accumulator programs, scale back CDHPs.

Top Employer Strategies for 2019

A survey conducted by the National Business Group on Health (NBGH) revealed the top strategies employers planned to use in 2019. To help curb your health care costs, be familiar with these tactics:

  1. Focusing on high-cost claims – Did you know that brand-name and specialty medications now account for almost 50% of drug spend, while accounting for less than 2% of pharmacy claims? This trend is the reason that 64% of employers are establishing more aggressive utilization management programs, such as requiring prior authorization, step therapy and quantity limits. Such strategies provide insight into clinical appropriateness of prescribed medications and protect the plan against unnecessary spending on high-cost drugs – and have minimal impact on the employee population.
  2. Implementing copay accumulator protection programs – The growth of drug manufacturers’ co-pay assistance cards or coupons for high-cost specialty drugs has created a problem for employers. NBGH found that more employers are implementing copay accumulator protection programs to ensure that assistance funds do not count toward plan deductibles or out-of-pocket maximums.
  3. Dialing back consumer-directed health plan (CDHP) options – NBGH reports a 9% reduction in the number of employers offering CDHPs as a sole option in 2019, showing that employers want to add more choice back into their plan options. By offering traditional health plans and $0 copayments for preventative medications, and contributing more to their employees’ HSAs, you can help lessen the pain of high deductibles while maintaining incentives for cost-conscious spending.


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