NEW YORK – More employers are using cost sharing as a utilization management tool in their prescription drug programs.
This is among the findings of a recent survey by Buck Consultants, an ACS company, which identified strategies employers are using to manage their prescription drug benefits and costs.
“Plan sponsors are clearly focused on controlling costs in response to budget cuts,” said Michael Jacobs, a principal and national clinical practice leader at Buck Consultants.
Nearly all (99 percent) respondents provide prescription drug coverage as part of their healthcare program for active employees. The two reasons given as most important for providing this coverage are the health of employees and business competitiveness issues.
Seventy-six percent of respondents use employee cost sharing as a utilization management tool, up substantially from 51 percent last year. The most common target cost-sharing range is 11 percent to 20 percent of claim costs (used by 39 percent of respondents).
“While the cost of prescription drug coverage varies widely, 30 percent, or the largest group of respondents, said pharmacy benefits represent between 11 percent and 15 percent of total healthcare costs,” said Jacobs. “This is down from last year’s survey, when the largest group indicated their drug benefits made up between 16 percent and 20 percent of total healthcare costs. This may be the result of many expensive brand medications moving off-patent and being replaced by lower-cost generics.”
According to the survey, the most important clinical management steps they are taking to control pharmacy benefit costs are broader based than prescription drug coverage. They include care management, disease management, and low-cost generic pricing programs offered by retail pharmacy chains.
“Our survey revealed disconnect with using low-cost generic pricing as a cost management tool,” said Jacobs. “While 73 percent of respondents cited are taking advantage of low-cost generic pricing offered by retail pharmacy chains as a high priority, only 26 percent require their mail service provider to match these low-cost retail generic prices.”
The survey found that the following top the list of strategic initiatives for long-term cost management:
• Providing employees with tools and information
• Providing employee education
• Adding consumerism to the program
Employers are now increasing their effort in managing specialty medications – complex drugs that are often injected or infused. According to the survey, 59 percent of respondents have included adherence to clinical guidelines as part of their specialty drug management programs.
“Employers are also more actively managing these specialty drugs to control costs,” said Jacobs.
Buck’s “Prescription Drug Benefit Survey” was completed in July 2009, and is the firm’s second annual survey on this topic. More than 140 U.S.-based organizations participated in the survey, representing a broad range of industries and employer size.
Photo obtained under Creative Commons license -Ed.
