Where Do Drug Benefits Go From Here?

As employers responded quickly to support employees during this health crisis, many have worked with their pharmacy providers to ease restrictions and promote safer distribution avenues for obtaining drug therapies. Now, as they look ahead to the challenges of providing a sustainable benefit program in a time of economic uncertainty, it will be critical to consider if the prescription drug plan should change to meet the organization’s objectives.

If, like many plan sponsors, you’ve allowed members to purchase larger quantities of maintenance drugs than usual, you can expect pharmacy utilization data will show some spikes in the early part of the crisis. These should eventually even out. However, employers may also see certain drug categories, like vaccines, exhibit sharp decreases in claims volume, and decreases in other acute therapy claims are possible as well. What this will mean for utilization in the second half of 2020 and into 2021 is not yet known; it will depend, perhaps to a large extent, on the future course of the pandemic. It’s possible claims will be higher than usual as people catch up on delayed care; it’s also likely that some treatment therapies that were put off will never occur. 

In light of the current health system challenges facing patients and prescribers, some employers are revisiting whether to move forward with certain drug cost-saving strategies or to delay them. At the same time, organizations that have been particularly hard hit are already looking for opportunities to reduce pharmacy benefit expenses without compromising their employees’ care. We are already seeing increased scrutiny of pharmacy benefit manager (PBM) and carrier agreements, either renegotiating the current vendor arrangement or exploring a new pharmacy provider arrangement. These efforts may be increasingly important for employers seeing significant fluctuations in the size and makeup of their employee population.

Another area to explore is drug coverage design and moving to more tightly managed formularies. It’s possible for a plan sponsor to realize over 10% savings with more aggressive formulary strategies. Employers should also consider ways to further advance certain site-of-care strategies that have gained traction during the pandemic; in particular, drug infusions at home. This alternative to hospital treatment can provide a safer, more convenient experience for the patient and family while delivering claim cost reductions of as much as 50%. 

As you set out to design a pharmacy strategy to align with current and future goals, it’s important to take the time to consider how the pandemic has changed the market, consumer expectations and patient behavior -- and ensure your program is based in the new reality

Raymond Brown
by Raymond Brown

North American Clinical Pharmacy Leader, Mercer

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