What's Affecting Rx Drug Costs and Tips to Control It

Employers, are high prescription drug costs making your blood pressure rise? Do you know that the pharmacy benefit is THE most used benefit? In fact, its used 3 times more than your medical plan! Prescription drug spending growth is at historically high levels – which makes it tough to contain Rx costs and maintain or improve the quality of care for your employees.

What's Affecting Cost?
With the pharmacy drug landscape continually changing, a number of factors are affecting drug costs:
  • Unbridled manufacturer cost increases
  • A specialty drug pipeline filled with expensive and much needed biologics
  • Inefficiencies and redundancies in the FDA drug approval process for generic drugs, slowing down more cost effective drugs from being released.
  • Employers running out of money to fund benefits and cost-shift to employees
  • Sick employees going bankrupt or trading on the Dark Web to get their medications
Twenty-seven percent of employers are using a high deductible plan to help control both pharmacy and medical costs. 50% of Americans don’t take their medication as prescribed, resulting in higher overall medical costs for the employer, due to lack of medication adherence. Since almost 75% of all office visits and 80% of all ER visits result in at least one prescription, it is logical that a clear understanding and focus on an employer’s prescription drug benefit is critical. This pharmacy benefit is complex, with many moving parts – some that can be controlled by an employer and their employees and others that cannot.

Tips to Control Costs
With double digit inflation on brand and biologic drugs, with more in the pipeline, every prescription drug plan deserves a keen focus on what drugs are being used, with programs and recommendations on alternative clinically equivalent medications. Here are a few tips to help control cost:
  1. An oral medication commonly used to treat Type II diabetes can cost well over $1,000 a month – but yet, there is a generic available for around $5 a month with the same common chemical. If you haven’t already asked your doctor for a generic version of your prescription medication, your savings can be immense. Bottom line - it is critical for every employer’s prescription drug plan to include clinical oversight, individual medication management and targeted programs to identify these and other types of savings.  
  2. If you are taking several medications for the same condition, ask your physician if there’s a single pill that would do the job. One example - treatment of high blood pressure - may require a brand name beta blocker and a brand name thiazide diuretic. Most people can substitute a generic combination pill containing both medications, which may have a lower copay of under $15. 
  3. Additionally, you may be able to split pills to save money. Ask your physician, because not all doses can be divided safely – but once you have the green light, ask for a script for half as many double-strength pills. Buy a pill-splitter and then cut tablets in two. 

When it comes to Pharmacy Benefit Management selection, the devil is in the details. What you don’t know CAN hurt you! If your medical plan is partially or fully self-insured, what would a 10% to 20% savings on your pharmacy costs mean to you? Is that worth a 30 minute conversation? If so, let's find those savings and provide better prescription benefits for your employees!

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


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