By Allison Binning
High Pharmaceutical Costs Got You Down?Skyrocketing drug prices are definitely a hard pill to swallow. According to the Congressional Budget Office, 1% of prescriptions for new specialty drugs accounted for 20 percent of spending ($25 billion). The top 10% of drugs by price make up fewer than 1% of all prescriptions but account for 15% of retail spending and 20%-25% of non-retail spending. Inevitable cost-shifting to employees for specialty and high-cost drug medications is squeezing employees’ pocketbooks and heightening stress and frustration. Here are a few ways that high-cost specialty drugs can impact an employee:
- They feel stressed and undervalued in the workplace, making it harder for them to do their jobs. Between diagnoses, doctor visits, routine labs, and changes in lifestyle based on their conditions and medications, plan members have so much on their plate that trying to pay for their prescriptions can be simply too much.
- Struggling to get their medications leads to a higher risk of hospitalization and health complications. It is vital that plan members that are chronically or acutely ill receive their medications.
- If a plan member has a limited amount of money to spend each month, they could be forced to choose between their basic needs and their medication. Either an employee can pay for their medication or their food and housing, or they forego their medication to pay for these essentials.
“Employers and their covered members are really being squeezed when it comes to cost and access to vital medications.” Says Keith Knowles, VP of Sales at CopayAssistRx. CopayAssistRx partners with consultants and benefits teams to help identify alternatives for high-cost medications, including both specialty and non-specialty medications. “Specialty costs are predicted to increase at a 20% plus rate annually…Continued cost shifting to employees undermines employee satisfaction and puts members at risk who elect to not fill needed medication due to cost concerns, which further increases costs.” Knowles says that the future of pharmaceutical spending is unfortunately expected to continue at the current rate of inflation and potentially even higher.
Alternatives to Specialty and High-Cost Medications
That’s why CopayAssistRx was built to work with, not against, the healthcare system to support employer and consultant goals of creating happy and healthy plan members. This non-insurance solution provides an integrated suite of pharmacy cost-containment solutions for employers. CopayAssistRx evaluates an employer’s pharmacy claims data to highlight specialty and high-cost drugs within the employer's spend. Care managers then work directly with plan members that have chronic or life-threatening conditions. Knowles says that “every member utilizing a medication under our management has a single care manager that works with them for as long as that member is with our client and taking that medication.” Care Managers work with the member to explain how they can comfortably continue access to the medication at the lowest possible cost via a number of options provided by CopayAssistRx.
What is an emerging trend CopayAssistRx utilizes to drive savings? “International sourcing is a solid option that is gaining interest with self-funded employers. Our partnership with a quality Canadian pharmacy provides plan members with high-cost medications and access to lower-cost alternatives that reduce their out-of-pocket expenses with no change in therapeutic outcomes,” Keith commented. CopayAssistRx provides lower-cost medications from just north of the 49th parallel to ease the strain on employees. According to Employee Benefits News, a pharmacy cost containment program like that of CopayAssistRx saves employers an average of 25% - 50% on specialty & name-brand medications.
“The results are clear,” Knowles says. “One example is a 1200-employee manufacturing client that saved $1.2 million in annual pharmacy spending when moving to our services. The savings are not just for the employer or the plan; the vast majority of members experience savings on their existing medication with our program. Some employees are able to avoid deductible and coinsurance expenses completely when working with their CopayAssistRx care manager while still driving substantial savings for the plan.” While CopayAssistRx can begin working with clients in the middle of the plan year, Knowles says many clients follow the annual plan review cycle to start working with the company. Prospective clients are offered a CopayAssist savings analysis that details available savings and medications and members affected. By addressing the baseline cost of approved medications, CopayAssistRx provides clear and quantifiable savings for the employer and its covered members.
The Ultimate Bottom Line
With lower-cost medications at your plan members’ fingertips and substantial savings generated for employers, CopayAssistRx provides a compelling option for the self-insured community. Knowles also offers a reminder to employers and brokers that healthcare is a bottom-line expense; “you can see results from CopayAssistRx in as early as 45 to 60 days if plan sponsors take action. Lack of action by a plan sponsor means valuable savings are either lost or deferred.” “Healthcare savings are a bottom-line expense, so engaging early means max savings for the plan and increased profits for the client.” But their ultimate bottom line, Knowles says, is fairness within the healthcare industry. “That is the way we do business and the way that we treat all stakeholders in the goal of reducing pharmacy costs for members and plan sponsors."
We are proud to feature CopayAssistRx on The Granite List.
