Top 3 Trends in Pharmacy Benefit Design for 2019

Top 3 Things You’ll Learn

  1. How to gain greater visibility into high-cost prescription drug claims
  2. How manufacturer copay assistance programs help employers maximize pharmacy dollars
  3. Why more employers are offering traditional health plan benefit options to their employees

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.

Among the top 3 strategies employers used to manage health spend in 2019 are focusing on high-cost Rx claims, adding copay accumulator programs, and scaling back CDHPs. These are still viable going into 2020 and beyond to help employers lower healthcare benefit costs.

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 their health care costs. Here are the top three:

  1. Focusing on high-cost claims – 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 manufacturer-provided copay assistance cards or drug coupons has created a problem for employers. NBGH found that more employers are implementing copay accumulator protection programs to provide support for high-cost specialty drug costs while ensuring that any applied 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, your clients can help lessen the pain of high deductibles while maintaining incentives for cost-conscious spending.

Learn more about prescription drug trends driving high costs for employers and other strategies used to combat those cost-drivers in our e-book, The Definitive Guide to Optimizing Pharmacy Benefits.


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