As the cost of specialty medications increases, employees want employers to bear the financial burden

As healthcare costs continue to skyrocket, employees want more help from their employers when it comes to footing the bill for pricey prescription drugs.

The spend on prescription drugs is predicted to grow to $5 trillion from $3.6 trillion by 2024, according to the Centers for Medicare and Medicaid Services. Annual prescription drug costs run about $1,200 per person, according to data from the Organisation for Economic Co-operation and Development.

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While 73% of employees have an employer-provided health benefits plan that includes prescription drug coverage, 80% said it is important that their current or future plan cover the cost of their and their family members’ specialty medications, according to a survey by RxBenefits, a pharmacy benefits optimizer.

“The cost of specialty medications is rising and becoming a burden for patients,” says Mark Campbell, vice president of clinical solutions for RxBenefits. “Employers must have a sustainable strategy to provide a rich pharmacy benefit that is both cost-effective for the company, as well as attractive to current and future employees.”

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Without a solution, employees are forgoing care: 49% of employees surveyed say they have experienced challenges in obtaining their specialty medications, due to factors like the overall cost of the medication or finding that the medication is not covered by their health plan. These issues are escalated to HR by 16% of employees, and 11% said they would change jobs to get coverage for their medications, RxBenefits found.

Employers can explore alternative ways to reduce costs while ensuring employees have access to the medications they need. Campbell says employers are looking at options like a specialty carve out, which is when the employer separates their prescription drug coverage from the major medical plan and the benefit is administered by a third-party vendor. Employers have also looked at excluding certain drugs in order to contain costs, a riskier option that could cause even more roadblocks for employees.

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“Many employers have begun to evaluate new methods to reduce the growing impact on their healthcare costs,” Campbell says. “Two methods being increasingly explored include specialty carve-out, or excluding specialty drugs from the pharmacy benefit altogether. While this may seem like an attractive option to contain costs, the approach is not effective for employers and can actually cause severe member and service disruption.”

Instead, Campbell recommends working with a pharmacy benefits manager who will negotiate price discounts directly with the drug manufacturers, and connecting employees with an advocate who will watch out for their overall health. This will take the pressure off the company’s bottom line and result in a happy, healthy, and more loyal workforce.

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“Nothing is more frustrating for patients than being left on hold for hours or being told to call 10 different numbers to get the answer they need about a prior authorization or a prescription,” Campbell says. “We have countless examples where our team has caught errors that would have otherwise slipped through the cracks, and worked with the employee’s physician to correct a prescription that not only saved them money, but also safeguarded their health and quality of life.”