As CEO of United Benefit Advisors, I hear continually about the issues facing our 36,000 employer clients. Managing prescription drug costs continues to be paramount. The UBA 2012 Health Plan Survey shows that 64.2% of prescription drug plans utilize three co-pay tiers (generic, formulary brand, and non-formulary brand); 2.9% have a one-tier plan, 8.2% retain a two-tier plan; and 24.7% add a fourth tier (specialty). Consultants should watch these plan structures carefully as many brand-name drugs go off their patents and pricing is determined for the influx of generic drugs. On the other end of the spectrum, we’re watching increases in specialty drugs, which are driving up costs significantly.
One UBA member firm, Capital Strategies, headed by George C. Gould, III, is doing particularly innovative work related to PBM. He says consultants should monitor the coupon and rebating strategies that seek to retain allegiance to brand-name drugs, which could affect the savings from increased generic drug availability. On some specialty drugs, Gould says that costs are so high, upwards of $30,000/month, that they are presenting an ethical dilemma for employers because there is no way to shift costs to employees. Neither employees nor employers can afford these skyrocketing costs.
