4 tips for better drug plan management
January 31, 2014 2:54 PM
1. Get back to basics.
Make sure you have a good contract. Make sure its renegotiated because price points in the drug market change annually. Thats [about] being a good steward and a good fiduciary to the plan, says David Dross, who leads Mercers managed pharmacy practice. Make sure the contract is updated and current.
2. Determine a target cost share for your plan members.
However you do it, whether its through flat copays or through coinsurance, make sure youre managing that cost share, says Dross. According to the PBMI report, the overall member cost-sharing percentage was 24% in 2012, compared with 25% in 2011. Consistent with previous years, member cost-sharing is highest for the retail-30 channel, at 29% and lowest for specialty pharmacies at 16%.
3. If you have a consumer-directed health plan, establish a reasonable preventive drug list.
Drugs used to treat some chronic diseases shouldnt be subject to the large deductible because if someone with diabetes has to pay a $1,500 deductible upfront before they start receiving benefits, that person is probably not going to be compliant. They will probably just opt out and not take the drug or take it on a less frequent basis than prescribed, explains Dross.
4. Keep an eye on specialty drugs.
Dross says its highly likely that within three to five years, specialty drugs will account for 35% or more of drug spend, up from about 20% today. Its going to be the thing that starts to make drug trend go back up, he says. And it needs to be managed.
