Pharmacy is 20% of all health care costs nationally. Are you doing all you can to curb pricey prescription costs? We’re here to offer a few smart ways your insurance plan can help lead you to lower costs.
95% of pharmacy costs are a result of chronic and complex conditions. Given that staggering statistic, many insurance companies are rolling out care management services to help employees work on personal health, which includes ways to manage or treat chronic conditions and recover from recent accidents or operations. Employees can speak directly—and frequently—to their care manager to establish and engage in personal health goals, which can include anything from weight loss to diabetes management. Check with your health insurance provider to see which care management options are available for your employees to help them reduce and even prevent the need for prescription drugs.
Medication therapy management
Something as simple as a 30-minute talk with a pharmacist can save employees hundreds each year. For employees on three or more prescription medications, some insurance companies are working with pharmacists to help verify the need for each drug, as well as ensure members are getting the lowest cost option on drugs, which in many cases, is the preferred or generic drug option. The medication therapy management program at Priority Health takes minutes (generally no more than 30 total), and can be done in person or over the phone.
Cost transparency tools
Just knowing there’s a lower-cost generic or preferred drug and choosing it over the pricier brand name can save members bundles on their medications. That’s why some insurance companies offer members transparency tools to help them see prescription medication options and costs. At Priority Health, Cost Estimator is available for all members. The tool lets you search the medications you’re prescribed and offers an estimated cost, as well as any possible lower-cost solutions. To date, it’s helped collective membership save more than $9 million. Priority Health also offers a transparency tool for providers to use in real time with patients so they can prescribe lower-cost alternatives when available. Ask your health insurer how they’re empowering your employees and their providers with transparency tools that help everyone save money.
Member and provider transparency tools are cutting edge, but the near future may hold even more innovations to help cure the rising cost of prescription drugs. A growing trend is in biosimilar medications, or biosimilars, which is the copy of an original drug. There are currently 18 FDA-approved biosimilars in the market, and that number is expected to grow, as many of these can replace costly, complex (and in many cases, specialty) medications used to treat cancers, MS and more. So far, the cost of biosimilars is anywhere from 15 to 30% lower than their original counterparts, which ultimately leads to lower premiums. Another thing insurers are doing to help mitigate the cost of prescriptions is learning how to lower the need for them in the first place. Population health is a hot topic that considers social determinants and how they factor into things like chronic illness, obesity and addiction. As insurance companies continue to learn more about the nature of why members develop illnesses that warrant costly drugs, they may learn to control the need—and the cost—in the future.
Between health management, transparency tools and tomorrow’s big advancements, there are ways to help cut the costly trajectory of medications. Ask your insurer if there are any immediate offerings available to you or your employees, and keep the dialog open between you and your insurance representative as you strive for affordable health care.