Study identifies 3 key trends expected to shape health benefits & costs
9 in 10 employers are concerned about high-cost drugs in the pipeline, with a similar number reporting concern about pharmacy cost trends overall.
“Our goal has been to equip employers and their benefits advisors with easy-to-use information to improve employee health, manage costs and understand program impact,” CEO Joy Powell said. “To accomplish this, our expert data scientists, clinicians and population health leaders dedicate significant amounts of time and resources to provide our community, customers and partners with these annual trend analyses that go beyond ‘what’ is driving costs in their population by delivering insight into the ‘why.’”
The wide-ranging report focused on three trends and how employers might respond:
Pharmacy spending. An increase of more than 1% in pharmacy spending is a major contributor to the overall 7% increase in employer-sponsored health insurance costs. A new study by the Business Group on Health reveals that amid increases in the percentage of health care dollars spent on pharmacy, 9 in 10 employers are concerned about high-cost drugs in the pipeline, with a similar number reporting concern about pharmacy cost trends overall.
“Ensure that strategies to address drug spending target both brand-name drugs and specialty drugs,” the report said. “The majority of drug spending is related to chronic conditions. Strategies aimed at the root causes of most chronic conditions, including diet, activity level, obesity and smoking, can result in reduced need for these drugs. Keep in mind that drugs that help members control their condition and prevent complications or progression can reduce other health care costs.”
High-cost claimants. These claimants are defined as individuals incurring $50,000 or more in total paid claims per year. From 2019 to 2023, the amount paid for the top 1% of high-cost claimants surged more than 15%, from $78,800 to $91,000. Further, one of every 1,000 plan members is likely to have total paid claims greater than $340,000.
“Understand the population at greatest risk of becoming a high-cost claimant based on conditions, history of being a high-cost claimant and demographic information,” the report said. “Consider whether the use of a clinical program partner addressing specific conditions or services would be cost-effective based on areas of greatest risk.”
Related: More Americans downgrading insurance plans to cope with rising costs
GLP-1 weight-loss drugs. At a time when more than 4 in 10 Americans are considered clinically obese, GLP-1 drugs show great promise for weight loss. They also are prohibitively expensive, and not all insurance plans cover them.
“Management of obese members must consider any previous methods employed to achieve weight loss, subsequent outcomes and individual member risk,” the report said. “Typically, programs focused on diet, exercise and behavioral modifications should be tried first. Medications or bariatric surgery may be considered for members who are not able to achieve or sustain weight loss.”