A new study reveals a sharp drop in the percentage of US employers that intend to continue offering prescription drug plans to people who are eligible for the federal Medicare health programme – ie, seniors and some people with disabilities.
Currently, 48% of employers responding to the nationwide survey said that they offer prescription drug plans to Medicare-eligible participants, but of these, only 55% reported that they intend to continue providing the benefit, compared to 75% in the previous survey.
However, nearly all (99%) of respondents provide their active employees with prescription drug coverage, an increase from 96% in 2011, according to the study, which was carried out by Buck Consultants and surveyed more than 250 organisations representing over 3.9 million covered lives.
The survey also shows an increase in the percentage of employers that contract third-party pharmacy benefit managers (PBMs) to process and pay prescription drug claims. 61% of employers now use PBMs, up from 57% in 22011 and 47% in 2009, and the majority (69%) cite “pricing competitiveness” as an extremely important PBM service.
“With many medications having double-digit price increases and with the continuing consolidation among PBMs, this is a buyer’s market for PBM pricing,” commented Paul Burns, principal at Buck Consultants.
“Employers should be aggressive in their negotiations – any PBM contract that is 18-24 months old should be reviewed for pricing competitiveness as well as up-to-date contractual language,” he advised.
The majority (71%) of survey respondents say they spend 16% or more of their total healthcare costs on pharmacy benefits, and 87% reported that affordable pharmacy benefits have a high impact on containing healthcare costs over the long run. This indicates that employers believe appropriate prescription drug utilisation can substitute for more expensive medical services, says the report.
“Pharmacy benefit costs continue to increase and, on average, currently represent more than 15% of employers’ total healthcare costs,” said Mr Burns. “If not managed effectively, prescription drugs can represent a constant financial drain on company resources and undermine the return on investment of a plan sponsor’s entire healthcare benefits programme,” he warned.
The survey also asked organisations how they are responding to certain pharmacy-specific requirements contained within President Barack Obama’s Affordable Care Act (ACA).
Of the two major categories of health benefit plans under ACA – grandfathered (ie, plans in existence on March 23, 2010, meeting certain requirements) and non-grandfathered (subject to a larger set of requirements) – only 26% of survey respondents report being grandfathered. Of the grandfathered plans, 42% said they plan to keep this status long-term, beyond 2014.
Most survey respondents said they provide coverage of immunisations under their medical benefit only, with around 20% offering such coverage under both the medical and pharmacy benefits, the study reports.
Also, while specialty medicines – used to treat chronic catastrophic illnesses such as multiple sclerosis and many cancers – are typically used by just 1% of covered employees or less, they represent at least 20% of pharmacy plan costs. Specialty medicines can cost $75,000 or more per year per course of treatment, yet more than 30% of the responding employers did not know the portion of their overall drug spend attributed to specialty medicines.
However, 67% of respondents said they use utilisation management programmes and 55% use step therapy protocols to manage specialty drug costs, compared with 45% and 34%, respectively, which said they did so in the previous survey. This indicates that more plan sponsors are recognising the need to manage these therapies whenever possible, the company comments.
