A single prescription drug can be the reason your health insurance costs jumped this year.
Not ten drugs. One.
Prescription costs have been climbing for years, and carriers build those increases into your renewal without much explanation. You get a number, maybe a general breakdown, and that is about it. Which medications are actually driving your spend rarely makes it into the conversation.
What we see more often than we should
An employer comes to us frustrated about their renewal. Their broker told them the increase was “just market trends.” When we dig into the claims data, we find one specialty medication accounting for six figures in annual spend. One employee, one drug, carrying an enormous portion of the entire plan cost.
The broker knew. Or should have known. Sourcing better pricing on a specialty drug takes real work, and unfortunately a lot of advisors are not set up to do it, or frankly not motivated to try.
You do not have to just absorb it
There are legitimate ways to source the same medication at a fraction of what your carrier is currently paying. In many cases, 50 to 70 percent less. Employees do not have to switch medications or change their doctors. This is not about making life harder for the people on your plan. It is about making sure they are not overpaying for something they need.
We built this process directly into the health plans we manage, so it works on an ongoing basis, not as a one-time fix.
A few things worth checking right now
Ask your advisor for a report showing your highest-cost medications. If they cannot produce one, well, that tells you something. Ask what they are actively doing to reduce specialty drug spend. “We negotiated a lower increase” is not an answer to that question. If you do have the data, look at whether any single medication is responsible for a disproportionate share of your spend.
Prescription drug costs are one of the biggest drivers of renewal increases, and most employers never get a clear picture of what is happening inside their plan. The data exists. You just need an advisor willing to pull it and do something with it.
A 20-minute conversation is usually all it takes to find out if there is an opportunity here. Contact us for more information.