In an article for Benefits Magazine’s June 2021 issue, RxBenefits’ VP of Clinical Solutions, Mark Campbell, PharmD, shares insights on rising prescription drug costs, COVID and non-COVID-related trends, and their impact on employer-sponsored pharmacy benefits plans. The article focuses on the top five data-driven clinical management strategies to help plan sponsors find savings opportunities while improving member health and safety amid rising Rx costs. The following is a brief excerpt.
Data-Driven Strategies to Manage Prescription Drug Costs
Implementing a clinical utilization management strategy as part of a pharmacy benefits plan can help identify areas of waste and reduce unnecessary benefits plan costs and has the potential to enhance value and safety for plan members. Designing a benefit that is tailored to meet plan goals and address the specific needs of an employee population begins with conducting a thorough analysis of utilization data.
By looking at a year’s worth of pharmacy claims data, plans can gain an understanding of what conditions, drug classes and specific medications are driving costs within the plan. An analysis can also show how many members could be impacted based on certain plan design, clinical program and formulary decisions. An important part of the 2020 plan performance analysis should include deciphering how the plan was impacted by COVID-19-related trends and how much of that is likely to become part of the group’s new normal. For example, groups that experienced member fluctuations in 2020 could see higher per member per month (PMPM) pharmacy benefits costs. In addition, with people sheltering in place for much of the year, there was a significant reduction in acute prescriptions for temporary ailments and an increase in prescriptions for chronic conditions, as well as a shift from 30-day to 90-day prescription fills and increased mail-order utilization.