When it feels like you’re caught between rising prescription drug costs and your company’s bottom line, HealthPartners is your partner with a plan.
Rising prescription drug costs affect all businesses
For business owners and executives, managing unexpected health plan costs due to rising prescription drug prices can be difficult to understand and navigate. We’re experiencing a perfect storm of new, high-cost drugs; rising chronic disease levels; frequent medication use; and rapid price increases for brand-name medications.
It’s a $335 billion industry… and growing
Pharmacy benefits are the most frequently used aspect of health care for Americans. Pharmacies filled nearly 19 prescriptions per person in 2019—with more than 75% for people with chronic conditions. The result? Americans’ overall spending on prescription drugs grew to $335 billion in 2018, and it’s projected to reach $511.1 billion by 2025.*
Gain pharmacy benefits insight and value
The easiest route to pharmacy benefits that improve employee health and lower net cost is to work with a partner whose business model is based on integrity and full transparency. HealthPartners will partner with your business at every step to gain visibility into the pharmacy benefits industry and get the most value from your pharmacy benefits plan.
A partnership you can trust
HealthPartners is the nation’s largest consumer-governed nonprofit health care organization. We deliver expertise, attention and a true spirit of partnership, building trust from businesses large and small.
America’s overall spending on prescription drugs grew to $335 billion in 2018 and is projected to reach $511.1 billion by 2025.
4 questions to evaluate the performance and value of your pharmacy benefits manager (PBM)
As a business leader, you’re probably feeling the weight of one of the biggest health care expenses affecting your bottom line—prescription drugs. Rising costs are leaving many employers feeling caught between healthy, happy employees and a healthy bottom line. To make things worse, the pharmacy benefit management system is so complex that it’s hard to know where to focus to reduce costs. The deeper you dig, the more frustrating it becomes.
In truth, pharmacy benefit managers (PBMs), who are often used as third-party administrators of prescription drug programs, can add cost or drive savings for an employer’s pharmacy benefit plan. But with so many hidden revenues and ulterior motives, it can be difficult to know whether a PBM is providing value or not. Experts agree that PBMs should be doing more to help lower prescription drug rates and pass along savings to employers. Today many federal regulators and states are investigating the opaque business practices of PBMs like never before.
Here are four questions you can ask to help determine if a PBM is prioritizing your best interest.
- Are your pharmacy benefits partners truly objective? It’s a good idea to check how your pharmacy benefit partners are paid. PBMs indeed receive money from drug manufacturers, but how much do they pass on to you as the plan sponsor? This question is crucial because it directly affects your bottom line. In many cases, there are hidden revenue sources that aren’t passed along to employers. One way to ensure objectivity is to find out whether pharmacies, where your employees buy their medications, get paid less by the PBM than what you’re billed. This is called spread pricing, a lucrative tactic that has more than doubled PBMs’ income from 2014 and 2016, according to Pew Charitable Trust. Spread pricing is often not disclosed to the employer which is why it’s critical to ask your PBM about their drug pricing.
- How cost-effective is your formulary? Understanding your formulary—the list of drugs your health plan will cover—is critical to reducing your health plan costs. It’s your best tool for managing costs. High prescription drug rebates may sound attractive, but they’re based on the high use of expensive brand-name prescription drugs. The result is wasted money on prescriptions when clinically equivalent generics are available for less cost.
- What’s being done to ensure high-cost drugs are dispensed only when medically necessary? PBMs should ensure that the prior authorization process—a health plan cost-control measure—requires a medical justification before disbursing any high-cost drug. It’s important to look for PBM services that support using lower-cost drugs first. One way to gauge this by looking at your plan’s generic utilization rate (GUR), which is the rate of generics are use as a percentage of all prescriptions in your plan. It should be at least 90%.
- How are plan members being supported to ensure that they stick to their therapy regimen? It can be hard to follow complex drug therapies when you’re feeling unwell and confused. Your members need support to ensure they stick to their medication plans to avoid extra expenses. Ask your PBM what they do to help keep people on track with their treatments. Look for medication management programs, with clinically trained pharmacists to review members’ medication usage and disease and case management services. These programs are vital to improving member outcomes and driving down overall health care spending. The easiest route to a pharmacy benefit that improves health and manages the lowest net cost is to work with a partner whose business model is based on integrity and full transparency.
Call 800-298-4235, and visit healthpartners.com/nd/planpartner to learn about group health solutions.
Visit healthpartners.com/pharmacybenefitfacts to discover the right knowledge you need to ensure your company’s pharmacy benefits plan is designed to bring the best value. HealthPartners is a nonprofit leader in bringing trusted care and award-winning integrated medical, dental and pharmacy benefits together for more than 60 years. We offer a range of health plan options for employers of all sizes in Minnesota, Iowa, North Dakota, South Dakota and Wisconsin.