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Is the Solution for Managing Pharmacy Costs Right in Front of Us?

Monday, March 23, 2020
Warren Olaya

Over the past decade, employers have struggled with rising health care costs and how to manage the bottom line while delivering robust benefits packages to their teams.  Traditionally, the costs have been shared via high deductible plans – but as families are now seeing out-of-pocket costs rising into five figures, and often high monthly prescription bills, the pressure is on businesses to shift their line of thinking.  

The How: Controlling costs and delivering a win-win back to the employee

It begins with data and predictive analytics. As an employee benefits broker, we are acutely aware of big data and predictive modeling. Still, mid-market companies with over 50-eligible employees can use the same process that large corporations utilize to achieve the cost reduction results they need.

As niche – and expensive – pharmaceuticals continue to be released, the cost back to the consumer will also trend upward.  The goal is not to deny critical medicines to the end-user, but rather to help prevent the diseases warranting the medications. So, what can be done?

  1. Assess.  By doing frequent in-depth analyses of a company’s pharmacy and medical claims, you’ll be able to identify trends.   
  2. Review.  Once data is collected, and trends are reviewed – it’s easy to see where the health risks are.  If you see a spike in costs for cholesterol medications, education and support to encourage employees to address the root cause of their high cholesterol versus medicating will not only help your employees lead a healthier life but will reduce pharmacy claims.
  3. Shift in Culture.  This is an ongoing process, not an overnight change. Creating a culture of wellness and letting employees know that it’s not just about reducing costs, it’s about having a healthy and happy team that’s important.  The goal is to reward good behavior, not punish bad. 
  4. Targeted Disease Management.  Over time of collecting, analyzing, and reviewing deep data, companies will allow the identification of trends and create very targeted disease management programs and particular wellness programs for employees.
  5. Predictive Modeling.  The goal is to identify WHAT triggers specific detrimental health trends and prevent the situation from happening in the future.  Perhaps requiring overtime of employees showed an increase in injuries or high blood pressure due to stress, lack of sleep, and the risk didn’t outweigh the reward?  

The trend of targeted wellness programs and predictive modeling is increasing.  It’s all about addressing the root cause of illness and injury versus fixing a symptom with costly prescription drugs.  We’re talking about a win-win situation for both employee and employer.  

We suggest working closely with your benefits consultant or advisor to craft a program that works for your unique situation to ensure success and the return-on-investment you desire for your employees.

Material posted on this website is for informational purposes only and does not constitute a legal opinion or medical advice. Contact your legal representative or medical professional for information specific to your legal or medical needs.