6 Ways to TAKE CONTROL of Your Pharmacy Benefit Spending

We are all witnessing healthcare spending continuing to rise at an alarming rate. What does an employer do? Cost shift? Increase deductibles, out of pocket maximums, co-payments and coinsurance? Reduce the network? Offer only a limited/closed formulary (drug list)? Increase the eligibility waiting period? Carve out specialty drug coverage? Implement mandates for mail order?  Review which benefit channel drugs are being dispensed and are the most cost effective? Pay a consultant to analyze high cost claims and look for cheaper alternatives? 

The top driver of health benefit cost increases today is prescription drugs. Drugs like insulin, blood pressure treatments, and cholesterol blockers have long played a critical role in employees’ health. Between May 2015 and May 2016 alone, prescription drug costs trended at 9.8%. In fact, the most expensive biologic breakthrough treatment regimens can exceed $750,000 per year! Specialty medication spending has nearly doubled since 2011, reaching more than $160 billion, for the entire US healthcare market. With roughly 40-50 new specialty medications entering the market each year, there is no end in sight.


While it can be tempting to cut coverage from plans because you don't know of another solution for dealing with these expenses, there are ways to take control of your prescription drug spending. Read further to learn how you can control drug costs without limiting the availability of them to your employees.

1. Promote a Healthy Work Environment
Taking care of your health is especially important this time of year. It all starts with eating right, drinking fluids, exercising and socializing. Educating your employees on ways they can improve and maintain their health, and offering incentives such as gym membership discounts, etc, is a great way to improve the overall health and wellbeing of your employees. Promoting a healthy, positive and respectful culture and work environment can help to significantly lower the cost of your prescription drug spending! Happier employees are healthier employees!

2. Offer Immunizations to Your Employees
An easy way to keep your employees at work and avoid flu, pneumonia and shingles, is to educate them about these immunization benefits and encourage them to consult with their physicians. These types of preventive immunizations are typically covered by prescription drug plans! They improve health and reduce healthcare costs.

3. Know What Treatments are Available 
Prescription drug benefits are the most used benefit, and the benefit that is MOST changing before our very eyes. “In 2017, one in four insured Americans were denied access to treatment for a chronic illness, according to DPRP.”  (Doctor-Patient Rights Project). During the past 3 years, leading PBMs are now excluding over 340 drugs, and some include generic drugs. Part of the rationale is to reduce costs, negotiating deeper discounts. But other drivers are to increase rebate revenue for brand drugs, in some instances that cost more vs their generic counterparts.

4. Ensure that Chronic Conditions are Covered
Remember, more and more drugs are being excluded from approved prescription lists. Others are so expensive it may be out of reach for many to afford. Offer information to your employees so they know where to go for help financially. There are resources available.

5. Stay on Top of Your Benefit Financials
Know your pharmacy benefit contract - its definitions, its exclusions, what it is silent on, possible pricing optics to make the discounts and fees look better than they really are. Know your rebate revenue paid on the claims your employees are using and that you are paying for. Are you getting 100% of them returned to you?

6. Fill the Gaps in Your Coverage
There are available solutions to help fill gaps for drugs and benefits not covered by healthcare plans. For example, you can sign up for a FREE discount pharmacy card that can save up to 15% to 80% on prescription drugs. There are also a variety of lifestyle programs available to offset cost shifts and high deductibles.

So employers, if your high prescription drug costs are making your blood pressure rise, perhaps it's time to call us to help you take control of your prescription drug spending. We provide customized prescription solutions for self-funded employers through our coalition contracts with major national pharmacy benefit managers and prescription assistance cards. We put medicine within reach, keeping dollars in employers’ and patients’ pockets.

Make sure to subscribe to our blog and social media accounts to learn more about what we do and stay up-to-date on the ever changing world of pharmaceutical benefit services!

Affordable Best-in-Class 

Pharmacy Benefit Management Solutions

Synergy Pharmacy Benefit Consultants, LLC
2111 Bagnell Dam Blvd #37
Lake Ozark, MO 65049

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