Pharmacy benefits in a telehealth world: The impact on self-funded employers
Kelly Chillingworth of RxBenefits explains how prescription drug utilization and costs have changed in the age of telehealth.
During the pandemic, telehealth service quickly ascended into the spotlight, offering consumers a safer (and more convenient) way to interact with their doctors and other health care providers. This change in consumer behavior and utilization has had a ripple effect throughout the health care sector, most notably the sudden surge in development of new digital health services.
One area of impact that employers and insurance providers might not have seen coming: prescription drug use. For many consumers, the ease of a telehealth visit meant an increased likelihood of seeking care (potentially resulting in a prescription being issued), as well as renewals of and better adherence to previously prescribed medications.
Related: 2021 pharma forecast: Expect shortages and supply chain disruptions
What does this mean for employers’ pharmacy spend? Kelly Chillingworth, RPh, MHA-Ed, director of business development at RxBenefits, recently shared some insights with BenefitsPRO.
What is the connection between prescription drugs and telemedicine?
Although telemedicine services were not new at the start of the pandemic, the demand for them increased during COVID-19. Restrictions on everyday health care services, including urgent care, routine checkups, and in-person mental health appointments, caused HR leaders to find efficient and attainable solutions to address member concerns over access to care. As a result, they had to increase the awareness of existing telemedicine benefits and, in some cases, potentially add or expand coverage for these types of remote services.
As some insurers began to offer telehealth coverage, we saw a rise in telehealth utilization among members. This increase in telehealth utilization has impacted medical and pharmacy benefit plans, and self-funded employers can attribute certain changes in prescription volumes to those encounters. Patients who saw their doctors via telehealth were triaged or diagnosed, often resulting in a prescription order. These orders were typically for acute medications to treat allergies and infections, but we also saw 90-day continuations of current medication(s) to treat existing conditions such as high blood pressure and high cholesterol.
How does the rise in telemedicine impact self-funded employers from a pharmacy-related cost perspective?
It’s important to note that telehealth services are not expected to raise prescription drug spend substantially, given that more costly specialty medications are unlikely to be prescribed for the first time via telemedicine. Prescribing that originates from a telehealth visit is typically seen as a replacement for what otherwise would have been an in-person visit for an acute condition, resulting in the prescribing of less-expensive generic medications. Additionally, when patients leverage telehealth for chronic conditions, any medications prescribed are typically ongoing therapy and represent refills.
Why is it important to evaluate virtual care offerings relating to member needs in order to build a competitive benefit?
Ultimately, offering a virtual service model ensures members are receiving the care they need until they are ready (or able) to visit their provider in person. It is convenient for members and, when a virtual visit is appropriate, it can also provide savings in the form of lower reimbursement rates and more affordable service fees than those billed at onsite consultations.
I feel that if an employee knows there is an actual accessible quality option for remote care in the event that they or a family member gets sick during an unprecedented lockdown, or even in the middle of a normal post-pandemic night, there is comfort – it is important that patients know they are not alone if something unexpected arises.
Although it can be challenging to predict the true impact of telemedicine and its associated pharmacy-related costs for self-funded employers, it’s clear that the impact will vary based on how members choose to utilize the services provided. Understanding the unique needs of your members can help them make more informed decisions on virtual care offerings. As employers increasingly explore telehealth options, evaluating offerings as they relate to member needs, preferences, and expectations will be essential to building a competitive benefit. The use of telemedicine services has trended down a bit recently as we attempt to return to normalcy, but the uncertainty of the new global variants may cause additional reconsideration of covered services in this realm.
Looking into the second half of 2021, what trends do you think will emerge in the benefits landscape as it relates to Rx and telemedicine?
We are closely monitoring how telemedicine’s momentum will continue as onsite health care facilities become more accessible. However, we do know that employers are increasingly evaluating telehealth options in some capacity, which will continue to have an impact on pharmacy benefits. Patient convenience, the desire to keep variant infection rates low, an uptick in business travel requiring remote care services, and the relative low cost of these services will impact coverage offerings.
We are realizing that previously avoided medical costs are fervently bouncing back in 2021, so incentivizing members to choose telehealth where clinically appropriate may be a way to balance this cost wave. Note: It will be important to encourage critical in-person visits for diagnostic cardiac and cancer care – these types of visits were often missed in 2020 and sometimes had unfavorable outcomes for patients who were unable to act in a timely fashion.
Additionally, the rise in telemedicine also brought the increase in virtual pharmacies, which accelerated during COVID-19 as patients were in need of more convenient healthcare offerings. For example, last year Amazon announced a remote retail pharmacy solution that will accept insurance and be in PBM pharmacy networks by leveraging PillPack, an online pharmacy that fills prescriptions by mail. Costco also recently announced a new online pharmacy, and local “brick-and-mortar” pharmacies are beginning to offer home delivery services as well. These virtual pharamcies are simply another option for members to fill their prescriptions, and as always, employers should be prepared to evaluate their pros and cons as compared to traditional pharmacies.
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