Features, Finance, Municipal Government, New York

Prescription for Controlling Pharmacy Drug Costs

September 30, 2019

By Adam Salomon, Producer

New York, NY — The experienced benefits experts at IMA Financial specialize in helping our clients manage their Health and Welfare plans.   Our consultative approach is an ongoing, year-over-year process that includes data and strategy review, compliance support, pre-renewal and renewal work, and support for implementation and year end responsibilities.   This cycle continually builds upon itself, forming into a well-developed strategic plan.

Not only do we identify and define your risks and exposures, we also provide the expertise to help you strategically and actively manage that risk as an educated and informed trustee or plan manager.  

Our team lives the motto of: Strengthening your fund: to protect families, businesses and plan offerings.

Prescription drug costs continue to rise, albeit it at a slower pace the last 2 years, placing continued pressure on health plans and members alike.   While slowing somewhat, prescription drug costs increased 6% from 2017 to 2018 according to the Milliman Medical Index, still outpacing medical increases (4.3%) and inflation (1.9%).   As a trustee or plan administrator, it is important to be continuously diligent in the management of your prescription drug program.  

As most are all too aware, the pharmacy market is layered in complexity:

Drug costs from Big-Pharma

PBM contract types – traditional, pass through

PBM contract nuances – definitions, exclusions

Industry pricing nuances – discounts, rebates, coupons

In addition, the rise in specialty drugs in both prevalence and costs adds another troublesome layer.   One pharmacy benefit management vendor has seen specialty utilization increase from .3% of scripts to 1.1% of scripts in the last 10 years, while the costs have sky rocketed from 13% in 2008 to 40% in 2018!

All of this creates immeasurable complexity for plan sponsors on a line item that accounts for nearly 20% of total plan spend on average.    

As a fiduciary, it is your responsibility to ensure that efforts are made to control costs for the plan and members.   No longer is it feasible to enter into 3-year Rx contracts and passively absorb the rising costs.   A plan administrator or trustee acting prudently, as a fiduciary, should heavily consider engaging partners that will educate and inform them and remain actively engaged to help ensure sound decisions are made and processes are followed.   This process should include periodic PBM marketing, annual contract performance audits and contract term negotiations, and clinical program reviews and recommendations from your advisors.

For questions, comments, or more information call Adam Salomon, Vice President Labor and Municipalities at 720-226-7261 or email at adam.salomon@imacorp.com

September 30, 2019

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