One-size-fits-all doesn’t work: How to customize pharmacy benefits for industry needs

Individuals in different industries work often possess distinct risk factors, creating the need for tailored health care benefits.

Managing the health of a large and chronically ill employee population can create a significant financial burden for self-insured employers. (Photo: Shutterstock)

As employee benefits advisors work with their self-funded clients to build the ideal pharmacy benefits plan for the coming year, one thing worth considering is the significant differences in employee populations’ health status from one sector to the next. Work and working conditions shape individuals’ exposure to a wide array of physical, environmental, and psychosocial factors that can influence health.

Related: 2020 workplace trend: The sunsetting of one-size-fits-all benefits packages

Individuals in the health care industry, logistics, retail and academia work in very different environments and often possess distinct risk factors—consider physical exposures to dangerous working conditions like COVID-19 or rotating shift work. Thus, they have specific needs from a health care and pharmacy benefits perspective.

Customized benefit plans: A Look at the trucking industry

The trucking logistics industry provides a prime example of why a customized pharmacy benefits plan is critical to meet members’ health needs and achieve an employer’s financial goals.

Member health needs

There are roughly 1.2 million trucking companies in the U.S. transporting around 10 billion tons of commercial products across the country each year. The industry’s 8 million total U.S. employees – particularly its 3.5 million drivers – have extensive wellness challenges different from other employer groups. Common health issues among truck drivers relate to the distinct job conditions they face daily:

Further underscoring these issues, a recent survey by the National Institute of Occupational Safety and Health (NIOSH) found that over half of surveyed drivers had two or more of the following risk factors for long-term preventable disease: obesity, smoking, little physical activity, high cholesterol, high blood pressure, or less than 6 hours of sleep per night. Additionally, commercial truck drivers have a 50% higher risk of developing diabetes than the general population, while 14% of commercial long-haul drivers have diabetes.

Compounding the issue, commercial drivers with diabetes also have an average rate of only 50% compliance with prescription drug adherence, which is lower than the general population.

Given their significant risk factors for long-term preventable disease, truck drivers have a high chronic illness rate. Left unmanaged or under-treated, these chronic conditions can lead to more serious medical conditions and catastrophic events, such as heart attack, stroke, and cancer.

Addressing health challenges through pharmacy benefits

Managing the health of a large and chronically ill employee population can create a significant financial burden for self-insured employers. The costs associated with medical events, such as heart attack and stroke, are astronomical compared to the price of managing chronic conditions with drug therapy and other preventatives. However, drug therapy can become costly as well, if not properly managed. The potentially high costs show why it is critical for self-funded employers in the trucking logistics industry to have a pharmacy benefits plan customized for their members.

For the trucking logistics industry, this process includes effectively managing their employee member population’s specific risks using a two-pronged approach that strikes a balance between drug access and cost:

  1. Contract management: The pharmacy benefits contract must include competitive rates and rebates, updated annually, and client-aligned terms that ensure the employer can purchase drugs at a fair unit price and that the plan will perform as expected.
  2. Clinical management: “Set it and forget it” doesn’t work here. The pharmacy benefit should be managed proactively on an ongoing basis, including having proper oversight in place to review the clinical appropriateness and cost-effectiveness of prescribed medications.

Because diabetes is one of the most prevalent health issues in the industry and medication adherence among drivers is lower than the general population, it’s essential to address this challenge through pharmacy benefits. A combination of effective plan design and independent, data-driven clinical oversight enables self-insured employers to manage the high costs of insulin medications while ensuring medication safety and appropriateness.

Also, through regular assessments of utilization data, employers can implement targeted clinical programs to help change behavior for things such as promoting medication adherence and self-management of the disease or intervening with physicians when dose optimization opportunities occur.

Customizing pharmacy benefits plans for member needs

To stay competitive in today’s challenging economic environment, self-insured employers and their members require a data-driven pharmacy benefits program tailored to address the nuances of their population’s health conditions and the drug utilization of its membership. Carve-in, or bundled pharmacy arrangements, rarely provide this flexibility.

By first carving out pharmacy benefits, you can help your self-insured clients access the specific pharmacy benefits providers and services to serve their interests. In turn, they can reduce their overall benefits costs while maximizing clinical value for their members. One of the most effective ways you can do this is to work with a pharmacy partner that leverages technology and a data-driven approach – such as advanced data modeling and predictive analytics – to deliver a set of meaningful insights and targeted recommendations.

As you’re working with your clients on their pharmacy benefits budgets for the coming year, consider whether their current arrangement addresses their specific industry’s health needs and the demographics of their employee population. It’s not too late to make changes for 2021.

Nathan White, Chief Client Officer, joined RxBenefits in 2017 with more than 18 years of experience in pharmacy client consulting, account management, and medication compliance and safety with both CVS Health and OptumRx. Nathan’s successful career is fueled by his passion for helping benefit consultants and clients cut through the complexity of the pharmacy ecosystem.

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