The fear of disruption keeps HR leaders from meeting their benefits goals every year. A plan change that would ultimately benefit members may never see the light of day because lowering plan costs and improving the benefits package for the entire team gets less consideration than the calls that may come in the weeks after implementation.

You can implement changes your company needs by limiting risk, minimizing disruption, and safeguarding member health. Disruption occurs whenever a member wants to use an element of their benefit but faces a hurdle. In pharmacy benefits, that often means getting prior authorization for a drug or engaging in step therapy. These tactics are sometimes vilified, but you can reduce the negative impact with a focused, tailored approach.

Here are three undervalued benefits of disruption every HR leader should consider:

  • Protect the entire plan from bloated drug prices.

No matter the benefits budget, there’s a finite amount any company is able to spend, and a small amount of disruption can protect everyone on the plan from rising premiums.

Disruption can be controlled by selecting the proper utilization management (UM) rules and focusing on the right drugs. By concentrating on high-cost medications that impact the fewest members, UM programs can focus on 90% of plan costs without disrupting 95% of members. Knowing the members, the most used drugs, and the formulary will make it easy to tailor pharmacy plans for the most beneficial financial impact while minimizing friction.

If there’s a need to make an exception to cover a specific drug or ignore a common rule, self-funded plans can work with their pharmacy provider and the member to create a solution. Beginning work early with the needed information can minimize the stress for everyone involved.

  • Build trust while supporting the team and minimizing disruption.

All teams balk at change, but leading everyone to a better benefits package can be an opportunity to build trust by helping the transition go smoothly. Support your team throughout implementation with clear communication about plan changes. For RxBenefits clients in 2022, 85% of prescriptions are written for low-cost generics, and the other 15% are written for expensive branded drugs, high-cost generics, and specialty medications. With UM programs focused on the few prescriptions behind the highest costs, the plan can limit the most risk. Connect regularly with impacted employees and help collect information and documents needed to get approvals to ensure even those members have a straightforward transition.

Be prepared to explain benefit choices and how the company will protect itself and its employees from rising drug prices. Be ready to share the “why” behind plan choices and make it clear these choices were made to minimize disruption while maximizing the value of the benefit for everyone.

For example, many companies choose not to cover weight loss drugs because they’re not as effective at treating obesity as bariatric surgery. The member avoids taking unnecessary medications and the potential side effects while keeping access to weight loss treatment. Other plans require step therapy to keep drug manufacturers from benefiting from hidden tactics that drive higher costs, like parity pricing — when a large dose of a lower-strength is used instead of fewer higher-strength doses. The member would prefer to take fewer pills, and the plan benefits from the lowered cost.

  • Avoid the side effects of what’s trending.

A lot can influence which medication gets written on the prescription pad: A doctor may have seen a previous patient succeed; a drug rep may have convinced them of a new treatment’s potential; or a TV ad may have driven a member to ask for the drug by name, and their physician sees no harm in fulfilling the request. Unfortunately, not every doctor is current on the latest medication research and pricing models, and sometimes, the drug written on the pad is not the best fit for the member. Overprescribing harms millions in America, and can often unintentionally drive up costs for employers and their members.

The rise of GLP-1s is a great example of a recent trending medication creating chaos for HR and patients. Treatments for type 2 diabetes, such as Ozempic®, Trulicity®, and Mounjaro®, are frequently prescribed off-label for weight loss. All drugs carry side effects, and if a member isn’t receiving the benefit of their prescription, they shouldn’t be taking it. In the case of GLP-1s, patients are reporting stomach paralysis and other side effects, and the run on these drugs for weight loss has left diabetes patients searching for medications they need.

By adding step therapy rules, many pharmacy plans started to catch this off-label prescribing and could intervene when members didn’t qualify for the drugs. While many people with diabetes who were prescribed the drug appropriately may have been impacted for a limited time, the overall effect of these new step therapy rules will be positive for the plan and patients.

Prior authorizations aren’t designed to deny care to patients who need it. When properly used to minimize member impact, clinical programs protect member health, plan sponsor’s dollars, and everyone’s ability to access necessary care. After just a few months of establishing the new normal, the benefits of reasonable levels of disruption will be clear.

Ready to plan next year’s benefits package? Ask your benefit advisor these five questions.