Pharmacy benefits can be a significant part of any company’s healthcare spend, and it’s important to be aware of the cost and steps you can take to reduce those costs. At the same time, you want to take care of your employees and ensure they have the benefits they need for chronic conditions or short-term illnesses.
Balancing your healthcare costs with the desire to take care of your employees requires a pharmacy benefit plan that’s flexible to your needs. These four strategies to control pharmacy benefit costs can help you find that balance.
Know exactly what you’re spending
In the traditional PBM model, there can be hidden fees that are paid back to the PBM or to the broker. Many companies aren’t aware of those fees because they’re just seeing a final price they pay rather than seeing the complete fee structure. That’s why it’s important to ask questions about what you’re paying and why. Ask to see the actual contracts so you can truly understand what you’re paying for when it comes to pharmacy benefits.
Customize your prescription formulary
Every pharmacy benefit has a formulary that specifies the member co-pay for different tiers, which is typically based on the actual cost of those medications. Generic drugs are in the lower tier while higher tiers contain drugs that are more expensive. As the benefit provider, you should have the flexibility to determine what drugs are covered under your plan and at what tier. Your PBM can work with you to customize the formulary to fit your needs and the needs of your employees.
Offset the cost of specialty drugs
By 2020, specialty drugs are expected to account for 50% of drug spending but only 1-2% of total prescriptions. For some conditions, specialty drugs may be the only treatment option available, and it’s important to ensure employees can access these medications when needed. However, they represent a significant cost for the employer. Connecting employees to the manufacturer’s assistance program can help decrease your plan’s exposure to the high cost of these drugs.
Know your data and take action on it
One of the most important things you can do to control your pharmacy benefit costs is know your data and take action based on that data. Is your plan paying for multiple higher-cost medications when a generic option should work? Are you paying for combination drugs at a higher cost than if the individual components were prescribed separately? At MaxCare, we combine data analytics and the extensive pharmacy experience of our clinical services team to help you make data-driven decisions about your pharmacy benefit.
If you’re ready to take control of your prescription benefit costs, contact MaxCare today to discuss how we can help.