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Pharmacy Plan Design

Prescription drugs are integral to high quality health care; they help prevent and treat acute and chronic conditions and can help patients avoid costly medical problems and unnecessary treatments. In the U.S., spending for prescription drugs accounted for about $324 billion in 2015 (Figure 1). However, the Centers for Medicare and Medicaid Services (CMS) predicts a continued annual spending increase of more than 6% from now until 2025, which means more than half a trillion dollars would be spent annually on prescription drugs by 2022. Alarmingly, up to 50% of prescribed medication is not taken as directed, contributing to excess waste and spending as well as to increased patient morbidity and mortality. Specialty drug spending, in particular, is of major concern for employers, with prices and utilization escalating at an unprecedented rate.

The pharmacy benefit is a major focus for employers given the high utilization of pharmaceuticals and their rising cost. Employers have implemented a number of techniques to manage spend through techniques including prior authorization, step therapy and utilization management. The National Committee on Pharmacy Benefits and Specialty Medicine focuses on ways employers can optimize their pharmacy benefits, as well as strategies for specialty medication management.

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Featured Resources

Large Employers' 2019 Health Care Strategy and Plan Design Survey Large Employers' 2019 Health Care Strategy and Plan Design Survey
This year, the survey was redesigned to provide insight into large employers' views on the rapidly changing health care environment. This new information accompanies tried- and- true elements of the survey: critical benchmarking information on health care costs, plan design trends and employer initiatives.

A Closer Look at Rx Coupons and Patient Assistance Programs A Closer Look at Rx Coupons and Patient Assistance Programs
Offers employer considerations and management strategies relating to copay coupons and patient assistance programs.

Prescription Opioid Misuse and Abuse Prescription Opioid Misuse and Abuse
Reviews recent progress in private and public efforts to tackle the opioid misuse and heroin epidemic and outlines employer strategies to stem the problem while delivering assistance to employees and dependents in need.

 

 

Also of Interest

Specialty Pharmacy Resources
Access all Business Group Resources on Specialty Pharmacy and explore a range of issues in specialty pharmacy management and strategies for consideration.

Business Health Agenda 2017: Key Insights & Learnings
A summary of latest trends, best practices and innovative tactics for employer-sponsored health benefits and health care initiatives gleaned from Business Health Agenda 2017.

What your CEO is Reading: Drug Pricing
Spending on prescription drugs by the two largest PBMs--Express Scripts and CVS Caremark-- increased by approximately 5% in 2015. Aggressive management of prescription drugs by the PBMs tempered, but did not eliminate, inflationary forces.

The Large Employers' 2017 Health Plan Design Survey
Survey data looks at what utilization management techniques employers use to manage select medications in their pharmacy benefits.

 

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