February 2012 NewsLetter, "A Four-Part Prescription for Managing the Cost of Pharmacy Benefits"

Abstract

With cost trends for prescription drug coverage still outpacing general inflation by a large margin, plan sponsors need to be vigilant in their oversight of this benefit. This NewsLetter discusses four emerging strategies for managing the cost of prescription drug coverage, one of which also aims to enhance the value of the coverage to participants:

  • Review retail pharmacy networks,
  • Maximize the utilization and cost effectiveness of generic drugs,
  • Combat direct-to-consumer “couponing” by brand-name drug manufacturers, and
  • Improve drug-therapy adherence through plan design and the promotion of personal contact between participants and their pharmacists.

This issue concludes with additional important considerations about the implementation of one or more of the cost-management strategies outlined above, including how to communicate the change(s) with participants. As with all health plan coverage changes, some plan sponsors will also have to consider the implications of their prescription drug coverage decisions on their “grandfathered status” under the Affordable Care Act.

The four-part prescription for enhancing pharmacy benefits and/or managing costs discussed in this NewsLetter is intended to augment, not replace, cost-management strategies already in place. The complex nature of prescription drug coverage means that no single approach or “silver bullet” can address the current and increasing cost. In addition to focusing on cost, it is also possible to introduce approaches that seek to improve participants’ health.

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