Tame Drugflation

When drug benefit costs loom, you’re not facing them alone.

What is drugflation?

The concept is simple enough: Drugflation is the term used to describe the skyrocketing increase in drug benefit costs that are sending healthcare spending into the stratosphere. The fastest growing component of healthcare spend (which is predicted to rise 7.1% a year over the next five years) pharmacy plan spending is increasing at a rate that’s more than 2x that of national inflation. Unbelievable. Unsustainable.

You’re feeling it already due to a perfect storm of:

Steep price increases for existing brand-name medications
Existing brand-name drugs being newly indicated for different conditions
A huge pipeline of high-cost specialty medications that treat rare diseases

An increase in high-cost specialty claims, stop-loss premiums, and lasering that excludes certain members from coverage
Favorable rates and rebates being extended only to the nation’s largest employers and health plans

Don’t get led down the wrong path.

What to do about it is an important question because, while you’re navigating the maze of pharmacy benefit options, you’ll encounter many promising paths that ultimately turn out to be dead ends. Let’s talk about a few of them.

Integrated carriers promise to reduce your administrative headaches and deliver additional savings by making better clinical decisions using integrated medical and pharmacy data. Sounds logical. They fail to tell you that their electronic prior authorization review process will automatically approve more than 90% of scripts, even when they’re not medically necessary or appropriate. And is it any wonder, considering they financially benefit from spread pricing, retained rebates, and dispensing fees every time a high-cost script is filled? You’ll also say goodbye to visibility into your pharmacy plan data and the flexibility to tailor your plan to meet the needs of your members.

The aggregate purchasing power of a coalition will improve your negotiating strength and unlock better rates and rebates. However, a great price on an unnecessary medication is still a waste of money, and that is exactly what will happen in an arrangement where the PBM continues to act as the gatekeeper. At the end of the day, you need a financially independent party to decide which prescriptions should be approved and which should be intercepted. To help members achieve the best health results at the lowest net cost, you need a high-touch service partner that will engage prescribers and members in making better decisions and extracting the full value of the benefit.

For about 10-15% of National Drug Codes (NDCs), National Average Drug Acquisition Cost (NADAC) offers pricing based on self-reported average drug acquisitions costs at retail pharmacies only. The selling point is transparency. But how transparent are those prices, really? Those averages don’t include the acquisition costs for specialty and mail-order pharmacies, nor do they factor in what your clients’ plan could recoup via discounts or rebates in a more traditional Average Wholesale Price (AWP) arrangement. When the lowest-net-cost math is done, factoring in discounts and rebates, AWP models typically win the day.

Some medications can be purchased for less overseas but it comes with shortcomings. From legal restrictions on drug importation, concerns about the safety of drugs that don’t face FDA approval, potential drug supply chain impacts and the lack of clinical management and financial oversight that come with purchasing a drug outside of the pharmacy plan, your clients might be risking more than they’d save. 

Most patient assistance programs are intended for indigent and/or uninsured patients, and the programs are cracking down on funding for patients with insurance coverage. Patient assistance funds are far from guaranteed for your members, making them an unreliable strategy for tackling pharmacy costs.

Not Rounded Drugflation Maze | RxBenefits Resources for Employers

Let a PBO
be your guide to
lowest net cost

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How do you tame drugflation?

Let a PBO guide you through the maze of pharmacy benefit options to arrive at the lowest net cost.

As the nation’s first and leading pharmacy benefits optimizer (PBO), RxBenefits will help you and your benefit advisor defeat the forces of drugflation, helping you secure a robust, member-friendly self-funded pharmacy plan at the lowest possible net cost so you can afford to take great care of your members, today and tomorrow.

A competitive, client-aligned

Contract

yielding an average

20-25%

savings in the first year

With more than 3M members and 3B in annual pharmacy spend under management, RxBenefits’ market-leading purchasing power will help you secure a competitive pharmacy contract that rivals that of a Fortune 10 employer. Competitive rates and rebates, client-aligned contract terms, and industry-leading guarantees that are reconciled annually will deliver 25% savings in the first year, on average, with annual pricing improvements in the 10%+ range.

Independent

Clinical Management

protecting members and saving another

5-7%

As an independent provider of clinical management services, RxBenefits doesn’t profit in any way from the approval or denial of a prescription. We don’t retain rebates and we don’t collect a dispensing fee because we don’t own any retail, specialty, or mail-order pharmacies. Instead, you can trust our clinical pharmacists to review the medical appropriateness of high-cost claims on behalf of your plan and members to ensure that the best medication to achieve the desired outcome is prescribed at the most affordable price. We partner with prescribers and members to help them leverage the benefit to its full potential so members can stay safe and healthy.

Supplemental stop-loss

Risk Mitigation

against catastrophic speciality claims

RxPharmacy Assurance provides multi-year, laser-free catastrophic specialty claims protection, covering virtually all specialty conditions, to mitigate risk and, in many cases, reduce traditional stop-loss premiums. The only insurance product available to specifically indemnify your plan against medically appropriate but high-cost specialty claims, this solution is a must-have to protect your organization against the inevitable budget buster.

High-touch and high-tech

Service

for a superior client and member experience

You’ll receive proactive, consultative advice from your dedicated account management team and all the data and insights you need to make informed decisions. Your members will receive personalized support via in-house, U.S.-based call centers, from compassionate representatives who are empowered to resolve member issues with a focus on solving problems comprehensively – not just ending phone calls quickly.