Larger Employers More Aware Of Need To Proactively Manage Employee Pharmacy Costs

Forty-nine percent of employers said they have an above average understanding of specialty pharmacy, according to a recent survey from the Midwest Business Group on Health (MBGH). This is a significant increase over a similar 2011 survey where 78 percent claimed to have a low to moderate understanding of this challenging benefit.

“With costs estimated to make up 40 percent of an employer’s total pharmacy spend by 2020, it’s essential that they focus their attention on managing this benefit—doing nothing is no longer an option,: said Cheryl Larson , MBGH vice president. “Since employers primarily fund health care benefits for employees, their understanding of specialty drugs and related costs will be a key factor in resolving current challenges.”

The survey also found the following:

• Executive leadership’s level of interest in understanding specialty pharmacy benefits was average to low for 53 percent of respondents.

• Twenty-five percent do not know what their cost increases have been over the past three years.

• Thirty-five percent are experiencing cost increases of 11 percent to 30 percent, while 10 percent are experiencing 31 percent to 50 percent cost increases.

• Thirty-six percent do not know their company paid medical costs specific to specialty pharmacy drugs and related services.

• Managing costs is very important to 86 percent of respondents and reducing inappropriate utilization is very important to 72 percent.

• For current specialty pharmacy plan design, 35 percent are using traditional pharmacy design of tiers, coinsurance, and/or copayments. Only 21 percent use special tiers with copayments and/or coinsurance.

• The majority of employers are still not offering incentives for requirements such as using a specialty pharmacy, participating in case management, or adhering to medications.

• Case management, drug utilization, and cost sharing are the top three priorities for managing specialty pharmacy benefits.

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