Concerns rising about drug management in HDHPs

Companies that offer high-deductible health plans (HDHPs) are seeing significant dissatisfaction from employees when it comes to drug utilization management, a new report has found. The report also noted that employer sponsors of HDHPs are paying attention to this dissatisfaction, as well as developments such as the Great Resignation, when it comes to designing benefits.

The study, by Pharmaceutical Strategies Group (PSG), an EPIC company and sponsored by RX Savings Solutions (RxSS), is called the Trends in Drug Benefits Report. For the report, PSG surveyed 153 benefits leaders, representing plan sponsors of an estimated 35.1 million covered lives.

Dissatisfaction seen from enrollees

The study outlined some possibly troubling developments with HDHP drug management and utilization.

For example, 57% of respondents cited member acceptance as a barrier to holding down costs and managing pharmacy benefits. Part of what might be driving the lack of support is the use of formulary exclusions. The use of such exclusions—which are intended to hold down overall pharmacy costs but can aggravate plan members who have to find alternatives—is highly unpopular, the study found. A large percentage of respondents, 69%, said member dissatisfaction was their top challenge with formulary exclusions. And that’s a problem, since 81% of companies in the survey said their plans had formulary exclusions.

Other problems with HDHPs and drug coverage, according to the survey, was lack of affordability before the plan’s deductible was met (22% of respondents), and lack of member understanding in using HDHPs (19%).

The employers’ viewpoint

Perhaps because of member dissatisfaction, plan sponsors have become less positive about HDHPs. “Thought the majority of respondents reported offering a HDHP, they expressed mixed views on whether these plans achieve their advertised aims,” the study said. “Only 35% of respondents agreed or strongly agreed that HDHPs are an effective way to manage overall drug trend. A somewhat larger percentage (51%) agreed or strongly agreed that HDHPs are an effective way to help members become better health care consumers and make wiser medication choices.”

The report added that these responses have changed since the last survey in 2018. In that study, 41% of respondents thought HDHPs helped manage drug trend (pharmaceutical costs to members) and 58% said HDHPs helped members become better health care consumers.

The study also found that companies that sponsor health plans seem to be paying attention to the concerns of their employees. The survey showed that 41% of respondents said the importance of member experience has increased somewhat or greatly since the start of the COVID-19 pandemic. A smaller number, 27%, reported that the Great Resignation has impacted their benefit strategy.

“Plan designs evolve, solutions come and go, and priorities shift. At the end of the day, consumers shoulder an increasingly unsustainable share of medical and pharmacy costs,” said Michael Rea, PharmD, founder and CEO of RxSS. “The research conducted by PSG will help inform drug benefit design decisions that work toward an elusive but important goal, one that is underscored by the impact of COVID-19 and the Great Resignation.”