From Wellbutrin to Ozempic, prescription prices are on the rise — how to mitigate costs

Given that the U.S. has a profit-centered healthcare system, it's not surprising to see substantial increases in medication prices, whether it's a weight-loss drug or blood thinners. But this is a reality that employers may need to start actively working against if they want a health plan employees can actually afford.

Nonprofit research company 46 Brooklyn found that pharmaceutical companies are raising prices for over 700 medications in January alone, with the average increase sitting at about 4.5%. Popular weight-loss drug Ozempic, for example, will see a price hike of 3.5%, while the antidepressant Wellbutrin will increase by 9.9%. Comparatively, an estimated 24 medications will drop in price, with insulin leading the pack after Medicare capped monthly prices were at $35. 

However, not all hope is lost. According to the Congressional Budget Office, more than 90% of the prescription drugs dispensed are generic and likely more affordable for the employer and employee. But the specialty drugs that make up less than 10% of what's being used are driving prices up for the whole system, and leaving employers with benefits budgets stretched far too thin. 

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That's why employers have to be strategic and ensure their employees have the tools to find the right medication for their condition at the best price, says Mark Campbell, SVP of clinical solutions at RxBenefits, a pharmacy benefits administrator that works with PBMs to get discounts on prescription drugs. 

"Having programs in place and people to help navigate the system and make the most appropriate choice is very important," says Campbell. "When somebody submits a prescription for Humira, maybe it makes sense to redirect that patient to something less expensive. You need to add a human component to a system-driven process." 

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For example, a drug like Ozempic may not be the fit for someone's condition — and at nearly $900 a month, it can be a large cost-sharing burden for both the employers and employee. Employees should know what medication is out there for them and the prices under their health plan, notes Campbell. This means having clinicians that can act as guides on a ready-to-use platform.  

"There's a wide dichotomy of what drugs cost that produce the same outcome," says Campbell. "As just an employer, it's really hard to translate that." says Campbell. 

Campbell reminds employers that ultimately employees should be able to afford their medication; if they're rationing or going for long periods without it, their health and ability to work will be impacted. Investing in healthcare tools could make a difference. In a healthcare system that's more costly each year, employers can't afford to ignore potential savings. 

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"So take somebody who has high cholesterol or high blood pressure, left untreated that patient is at high risk for having an adverse event that could cause death or a significant decrease in their overall quality of life," says Campbell. "If we want patients to make better decisions, we can't expect them to do that unless we can give them better information to understand clinically and economically, what choices they're making."