One perennial trend that will continue to grow in importance in 2019 is the quixotic quest for transparency in the prescription drug marketplace. Benefit professionals cannot access the list prices of the medications that employees take, nor can they easily compare prices to determine if there are more cost-effective options available. With increased transparency, benefit professionals could identify the major price variations that exist between different brand name and generic options of therapeutically equivalent medications on the formulary.

Price transparency has been especially difficult to achieve because pharmacy benefit managers (PBMs) tend to obfuscate the underlying pricing mechanisms and negotiations that occur with pharmaceutical manufacturers, retail outlets, and so on. Though 2018 saw everyone from benefit managers to consumers demanding more transparency in the pharma marketplace, most pricing information is still a black box. Faced with this challenge, in the coming year more benefit professionals will seek out new, creative solutions that make pricing information more accessible and work around the opaque PBM business model.

One approach that will continue to gain traction in 2019 as a viable solution to the transparency issue is prescription reference-based pricing. This approach works within PBM formularies and uses complex algorithms to identify the most expensive drugs used by the employee population, highlight more cost-effective alternatives, and then encourage members to switch to the most affordable drug. Reference-based pricing is proven to reduce pharmaceutical spend by an average of 20 percent per year by highlighting instances of tremendous price variation between a brand name drug and the generic equivalent, and even between a high-cost generic and a similar, low-cost generic option.

Some experts believe prescription reference-based pricing will become the standard for how care is priced and paid for in the United States. By compensating for a lack of transparency in the marketplace, reference pricing gives benefits professionals more control over how much is spent on pharmaceutical benefits, while also providing employees the option to choose a different, therapeutically equivalent medication, with the understanding that they'll pay the difference in price. In this way, initiatives like reference pricing allow benefit professionals to work with transparent drug cost data, resulting in significant savings which can be applied to other areas such as wages and additional ancillary benefits.

Start planning for 2020 today

Most of the future is uncertain, but many benefits professionals agree that pharma costs (and all health care costs) will continue increasing, and now is the time to start strategizing and taking action to mitigate those growing costs in 2020 and beyond. To stay competitive and retain quality employees, future-proofing the benefits program will be less about slashing benefit levels or increasing copays and deductibles and more about making smaller tweaks on a regular basis. More benefits professionals will be targeting those couple big high-value programs to roll out in 2019 to implement positive change in the benefit program for the coming years.