In an article for Employer Benefit Advisor, RxBenefits’ Chief Executive Officer, Bryan Statham, explains five critical components for an effective utilization management strategy. He describes the highest cost drivers impacting pharmacy spend and how to address these costly challenges in a way that keeps employee health at the forefront. Following is a brief excerpt; you can read the full article here.
How a Clinical Management Strategy Can Reduce Pharmacy Spend and Improve Employee Health
Before the COVID-19 pandemic hit, pharmacy spend was expected to hit $560 billion in 2020 — a 66% increase since 2015 — and continue to grow at least 6.1% year-over-year for the next seven years. That figure will likely increase with uncertainties surrounding long-term care for recovered coronavirus patients and rising costs of specialty drugs.
Many employers worry about how medication costs will impact their healthcare spend and benefits budgets, which are already strapped. The reality is, however, that pharmacy benefits spending has changed dramatically in the last 10 years — with high-cost specialty drugs now accounting for 40-50% of overall prescription drug spend. Often just one utilizing member can cause a drastic shift in a company’s spend.
Implementing a clinical utilization management strategy as part of a pharmacy benefits plan can help reduce costs for the employer. At the same time, it increases value and safety for members by addressing high-cost, low value pharmacy claims.