Recent findings from Mercer’s US book-of-business health benefits database — Mercer FOCUS — show that nearly 70% of employers’ total combined medical and pharmacy cost trend of 3.1% was attributable to both specialty and non-specialty pharmacy increases. In fact, even for employers with negative combined medical and pharmacy claims cost trend, this pharmacy trend is nearly 8%. Mercer FOCUS data shows that employers materially offset this rising pharmacy trend with very moderated cost and utilization increases in every other service category.
These findings, which reflect very recent claims data (paid through September 2014) for more than 3 million active employees and their families across many carriers and employers, are echoed in a recent Wall Street Journal article, Prices for Prescription Medicines Rose How Much Last Year?
Fortunately, there are steps employers can take to restrain cost growth. Here are just a few of Mercer’s suggestions:
- Determine whether specialty medications are best covered under your medical or pharmacy programs and take steps to steer members to the most appropriate source.
- Assess the impact and ROI of current utilization management programs — particularly for specialty drugs.
- Consider various disease-specific support programs that may reduce costs.
- Check that all compound medications require prior authorization and that both quantity and dollar value limits are in place.
This is one of those times when you want to be an early adopter. Waiting to take action may cost you.