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Thu., May 17, 2012 11:04am EDT (Reuters) — Employers want to step up programs to encourage healthier behavior among their workers and to control spending on expensive injected specialty medicines, according to a survey by pharmacy benefit manager Express Scripts Holding Co.
Cost is increasingly a concern as employers formulate their prescription drug plans, according to the survey of more than 300 benefit officials.
Five years ago, 57% of respondents said their prevailing philosophy for a pharmacy benefit was "providing the broadest coverage." But now that number has fallen to 14%, while 78% now support "balancing cost with care," up from 41% five years ago.
"The market in a lot of different places has said more choice is not necessarily better," Tim Wentworth, Express Scripts' president of sales and account management, said in an interview.
The survey by Express Scripts, the largest U.S. manager of pharmacy benefits, also found that 36% of plan managers cited use and cost of specialty medicines as their biggest concern. For employers with more than 25,000 members, 58% named specialty costs as their top worry.
Specialty medicines tend to be injected or infused for conditions such as cancer and rheumatoid arthritis and can cost tens of thousands of dollars a year. Many of the new drugs hitting the market now and expected to do so over the next few years fall into this category.
Specialty drug spending rose 17.1% last year, while overall spending on medicines increased only 2.7%, according to Express Scripts.
Wentworth said such spending tends to make up less than 30% of a client's overall drug spending but "it is the fastest-growing component, and so they want to put things in place now."
For example, the vast majority of survey respondents expected to institute programs that require members try the lowest-cost drug that is appropriate before starting on a new drug — called step therapy — in the next two years.
More than 75% of plan sponsors say behavior-driven conditions are the greatest contributors to rising healthcare costs. So while only 58% say they currently use wellness programs, such as financial incentives to stop smoking or monitor weight, 81% plan to do so in the next two years.
One example of efforts to influence behavior from a pharmacy perspective is plans that lower co-payments for medicines for chronic conditions, such as high cholesterol, to encourage members to stay on their medicines.
"This is a broad acknowledgement of how critical addressing behavior is to reducing health care costs," Wentworth said.
(Reporting By Lewis Krauskopf in New York; editing by Matthew Lewis)
© 2011 Thomson Reuters.
