All Pharmacy
Benefits Plans Are
Not Created Equal
A Human Resources Guide
to Finding Your Perfect Fit
It should be no surprise to anyone working on an HR team tasked with finding the right employee benefits solutions that today’s pharmacy benefits landscape is complex. Ongoing increases in prescription drug costs, a robust pipeline of high-cost drugs expected to come to market, and the often-opaque practices of leading pharmacy benefits management (PBM) companies can make balancing a benefits plan’s goals – including cost savings – and member needs seem like an insurmountable challenge.
Cost-Centric or Member-Centric?
There are some key considerations for HR teams when evaluating available options and seeking to find the one best suited to their employer plan’s objectives, depending on whether cost savings or member experience are a higher priority.
One important factor in determining plan goals and design is the employer and HR team’s level of comfort with member disruption.
What Is Member Disruption?
There are several tools and tactics plans can use to reduce the plan’s pharmacy spend, including:
- Step Therapy: Requiring the use of a clinically equivalent, lower-cost alternative first
- Formulary Exclusions: Removing certain high-cost drugs from the formulary and not allowing members to fill prescriptions for them
- Easy Switch: Switching prescriptions written for high-cost drugs at the pharmacy counter to a lower-cost, clinically equivalent alternative
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