Self-funded employers can often run into roadblocks when it comes to managing their pharmacy benefits, as they work to ensure employees have access to high-quality medical care that won’t break the bank for either party.
Every year during open enrollment, RXBenefits, a pharmacy benefits optimizer, hears the same common misconceptions — and this year they want to debunk those myths.
“Some of the most common questions that I typically get revolve around cost and access,” says Bradley Nelson, the director of clinical services at RXBenefits, which helps employee benefits consultants meet the needs of their self-funded employer clients. “Employers wonder, if they want to save money, ‘does this mean that I'm decreasing the benefit to the point where it can be adverse to employee retention or employee engagement?’”
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The answer to those questions, Nelson says, is no. The biggest roadblock when it comes to pharmacy benefits is cost, which, like most elements of healthcare, is on the rise.
“Pharmacy used to be about 10 cents on the dollar spent on healthcare, but it's approaching 20 and 30 cents today,” he says. “Once pharmacy began to increase in importance, how to increase accessibility and mitigate that ever increasing cost really became the question.”
But employers don’t have to accept the status quo, and there are solutions out there to help manage costs without scrimping on quality.
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“Partnering with someone who is an expert in pharmacy is important,” Nelson says. “This is someone who can be that interpreter of data for you, and help determine whether or not you really are going to create an impact and a sustainable solution over the long haul.”
Another strategy to consider is adding an authorization review into your pharmacy benefit plan, which can allow for an independent review of the treatment plan before it is put in place and eliminate the use of unnecessary or inappropriate treatments and care.
“Making sure that there's a level of independence is extremely important to help guide members to the lowest cost alternative,” Nelson says. “And then you also have the idea of optimizing your formularies to exclude certain medications and guide members to a medication that is more appropriate and a lot cheaper.”
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Communication is the biggest factor when it comes to helping employees make the best healthcare decisions, Nelson says. Connecting with experts that can help employees understand the way the healthcare landscape has changed can play a vital role, especially because it can be a lot to ask of your HR coordinator to handle all of this on their own.
“As far as the transformation of the healthcare landscape, you need those experts that are there to help not only you as director of the benefits portion of the health plan, but you need them to help guide your members so that your members have a greater level of understanding,” he says. “So communication is the key.”
