It is mid-September, which means if your health plan renews January 1, your renewal is probably starting to take shape. Maybe you already have it in hand.
Before you sign off on another increase, there is one area worth a closer look this year: your pharmacy claims.
Why Pharmacy Deserves a Second Look
Prescription drugs now make up more than 25% of total health care spending for the typical employer plan. Specialty medications, while used by a very small percentage of members, can account for more than half of total pharmacy costs.
That means just one or two high-cost prescriptions can add hundreds of thousands of dollars to your plan in a single year.
Here is the encouraging part: pharmacy is often one of the easier places to find savings before your renewal is finalized.
Where the Opportunity Lives
Depending on which medications are driving your claims, there are a few strategies worth exploring:
- International sourcing for certain high-cost specialty drugs
- Specialty drug carve-outs that separate high-cost medications from the rest of your plan
- Manufacturer assistance programs that can significantly offset member and plan costs
Used well, these approaches can create meaningful savings without asking your employees to sacrifice the quality of care they are used to.
Three Questions Worth Asking
Before you accept your next renewal, bring these three questions to your advisor:
- Which medications are driving our highest claims?
- Are any of them eligible for alternative sourcing or assistance programs?
- What are we doing to lower these costs before the renewal decision is finalized?
If your advisor cannot answer these clearly, that is worth noting too.
Do Not Wait for the Increase to Look for Solutions
The best time to look for pharmacy savings is before renewal, not after. A little bit of review now can make a real difference to what you are asked to sign in January.
If you would like a second set of eyes on your pharmacy costs before your renewal is finalized, we would be happy to take a look.
DM me for more information.