This enrollment season, target drug costs to control benefit spend

More than any other element in the cost of health care, the prices of prescription medications are soaring. And as companies try to contain benefits budgets in advance of this year’s open enrollment period and the need to choose which health plans to offer, they’re looking for ways to rein in prescription costs.

Health care data analytics company Innovu has issued a white paper, “6 Tips for Managing Employer Rx Costs,” to help employers project more accurately what they’re going to spend on prescriptions in the months to come.

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Innovu says that projections from the Office of Actuaries at the Centers for Medicare & Medicaid Services indicate that health care expenditures will make up nearly 20 percent of U.S. gross domestic product by 2026—thanks in large part to more expensive specialty drugs.

Skyrocketing costs, however, tend to push employers to figure out ways to shift some of those costs to employees, but workers are already having a tough time with medical expenses. One way to deal with the issue, says Innovu, is for employers to be able to predict more accurately how much their health care costs will be.

The white paper offers six steps to project those costs more accurately. While some require the use of data analytics to understand which medications employees are taking, others only need a little time on the part of the benefit advisor or employer staff.

Among the suggestions made by the white paper are projecting future price increases, as well as anticipating even more expensive drugs now in the pipeline. The paper says employers using historical utilization data for such projections should take into account specific increases, in the case of high-cost specialty drugs, which rose by 9.7 percent in 2018. If they lack specific data, they should rely on data from the most recent CPI-U.

They should also take into account how such drugs are administered, since if providers administer them in the office, they can be as much as 50 percent cheaper than if they’re given in an outpatient hospital setting.

Employers should also be aware of specific conditions, such as migraines, among their employee population, so that they can anticipate the addition of new high-priced medications such as the new class of migraine drugs that are vastly more expensive than those already in common use.

Other suggestions include requiring prior authorization, greater use of new generics, action on rebates and benchmarking how well plans do compared with those of other employers.