Studies show that pharmacy benefits are one of the fastest-growing components of health care, and represent 21% of the employer’s total annual health benefits cost. It is also projected to increase by 13% this year.
We all want lower pharmacy costs, but we all also want increased member satisfaction. While the two seem like opposite hemispheres, they can be brought together with proper pharmacy benefits management.
Find Someone You Trust
The first smart step to managing pharmacy benefits is identifying an expert to assist in negotiating a contract that is rooted in transparency and accountability. The professionals from Crystal Clear RX, for example, agree on the importance of a legitimate third party in navigating the complex PBM contract.
Promote Other Channels
Instead of allowing access to countless options, an employer can save a whole lot in prescription spending by narrowing the number of network pharmacies and promoting low-distribution channels. Encourage members to utilize a mail order pharmacy for maintenance medications as it can lower costs.
Consider Specialty Patient Management
Specialty patients generally have serious illnesses with complex drug therapies that require monitoring and counseling. Retail pharmacists are not staffed to manage the complexities of a specialty patient. By providing increased care, a PBM’s specialty pharmacy can lower costs significantly compared with retail.
According to experts, each 1% increase in generic drug utilization, costs an employer a decrease by 2%. Although a physician must first approve therapeutic substitution, this has been proven to show the most significant savings. Maximize and promote generics to members.
The pharmacy benefit is complex, and the market dynamics are ever changing. Clearly communicate not only the changes, but also the multitude of ways members can navigate their benefit to lower their out-of-pocket costs through generic utilization, mail order, narrow networks and low-cost formulary brands.