Viewpoints from Briana Loff
Every year, Express Scripts (ESI), one of the nation’s top leading pharmacy benefit managers (PBMs), releases its annual drug trend report. Their report for 2019 analyzed costs and spending for over 33.6 million members currently enrolled in one of their drug plans. Express Scripts noted this is the third year in a row they’ve been able to keep drug spend under 3%, which is a huge deal.
The top cost drivers for 2019? Inflammatory conditions such as psoriasis and rheumatoid arthritis, which drove 43.7% of spending.
To give you some reference, diabetes and oncology drugs each contributed less than 20% of spend. ESI also noted that the impact of specialty drugs is continuing to grow. It’s a concern when 2% of prescriptions account for nearly half of spending in any given year.
Craig Hasday wrote about the importance of actively managing pharmacy costs earlier this year. With the ludicrous price tag on specialty pharmaceuticals, it’s imperative that employers know which drugs are driving costs and how to best mitigate them. Medical carriers struggle to provide their clients with the best possible pricing and PBMs typically provide better rebates because, well, that’s what they do.
We frequently take pharmacy plans out to market to help identify savings for our clients.
As murky as pharmacy pricing is – and that’s putting it lightly – a PBM is able to provide more insight into those costs than a medical carrier. PBMs can offer quarterly and annual reporting, multiple levels of audits throughout the plan year, end-of-year contractual rebate reconciliation, formulary optimization and pricing improvements. All of this results in savings for our clients.
Negotiate with the pharmaceutical companies. If your medical plans are currently self-funded and your pharmacy plan is with your medical carrier, maybe it’s time to explore the option of carving out your pharmacy plan. This is where EPIC can help.
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Account Manager, Employee Benefits – New York, NY