Managing employee benefits: How to combat rising pharmacy costs

By Higginbotham on February 13 , 2020

prescription drugs

Prescription drug costs have become a key issue for both workers and their employers. According to the CDC, 60 percent of U.S. adults between the ages of 18 and 64 were prescribed medication during the previous 12 months. This means that the majority of your workers are likely taking at least one prescription, possibly more, during the average year.

As prescription costs continue to rise, controlling this expense is becoming more and more important. Luckily, there are several strategies that employers can use.

Review Your Benefit Packages

Employers need to take an active role to ensure that cost-saving measures are being taken. Engaging a pharmacy consultant can bring immediate cost-savings to many employers, especially those with 500 or more employees.

  • Review your prescription drug plans. Drug plans can vary significantly in terms of which prescriptions drugs are covered on the formulary and how drug tier pricing works. Review plan options to verify that your company and its employees are getting the best value.

  • Do your due diligence with a pharmacy benefit manager. A pharmacy benefit manager (PBM) can help your company manage its prescription drug benefits. However, employers still need to stay on top of managing prescription costs. Before selecting a pharmacy benefit manager, do your homework to ensure that you will receive value from the arrangement, and review the performance regularly. Additionally, many contracts with PBMs are marketed as transparent or with rebates included. However, sometimes there are hidden costs in the fine print that can cost upwards of $15 PEPM.

Engage Your Employees

It’s important to offer prescription drug benefits that provide a good value. However, savings might not be realized if employees don’t know how to use their benefits effectively.

Think about this common scenario. An employee goes to his normal pharmacy to fill a new prescription. The copay is surprisingly expensive. Does the employee (A) hand over the money, (B) decide not to fill the prescription or (C) look for ways to reduce costs? In many situations, the answer will either be (A) or (B). In fact, many people many not even realize that (C) is possible.

Although employees don’t like paying high out-of-pocket costs for prescription drugs, they might not think they can do much about it. Give employees the knowledge and the tools they need to keep their prescription costs down.

  • Explain how copays and deductibles work in the various plans that are available.

  • Encourage comparison shopping. The same prescription might cost different amounts at different pharmacies, but not everyone is aware of this. Educate your employees on the importance of shopping around. Apps like GoodRx can help employees find the best price. However, be aware that many programs like GoodRx, while saving employees money, actually utilize an out-of-network PBM; so money spent with them may not go toward the employees' deductibles.

  • Don’t forget about mail-order pharmacies. Mail-order pharmacies often provide deep discounts. They’re also very convenient. Despite this, workers who have never used them before may be reluctant to try a mail-order pharmacy unless someone else suggests it. If your benefits package includes a discount for mail-order pharmacies, make sure your employees are aware of this.

  • Consider coupons. For expensive prescriptions, encourage employees to look for coupons and discounts provided by the drug manufacturer.

  • Teach employees to inquire about the out-of-pocket cost of a prescription. In some cases, negotiated plan rates are actually higher than the out-of-pocket cost. Pharmacists often don’t volunteer this information, but they will share it, if asked.

  • Encourage employees to talk to their doctors or pharmacists about all of their medications and supplements. Many people take multiple prescriptions, over the counter medications, vitamin supplements and more. Some medication combinations have side effects that can be costly and dangerous.

Need more ideas or assistance? Contact the Higginbotham benefit services team

Tags: Employee Benefits


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