Common Pharmacy Myths… Busted!

To shield your self-funded clients from clinical and financial risk in their pharmacy benefits programs, it’s important to consider market trends and best practices when making decisions. Below we’ve busted a few of the most common myths about how prescription drug trends really impact your clients.

The pharmacy benefit myth busters are on the case! These 3 things could be causing you to overpay on your employee Rx plan.

Bradley Nelson, PharmD

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Beware: These could be causing your clients to overpay on pharmacy benefits.

Myth 1: Specialty drugs account for more than 40% of Rx spend and the majority of claims.
Busted! While it’s no surprise that specialty drugs are having a major impact on your clients’ pharmacy plans, the truth is this impact is being caused by less than 2% of claims.

The good news for members with rare conditions is that they are getting access to treatment they need. The challenge for employers is that one or two high-cost drugs could have a dramatic impact on the budget. The trick to managing prescription drug costs is to eliminate wasteful spending by ensuring that all drugs being paid for are appropriate and that the pharmacy benefit plan is not overpaying unnecessarily.

Myth 2: Optimizing the formulary to exclude drugs limits member access to needed medications.
Busted! Optimizing the formulary gives members access to essential medications and redirects them to more clinically effective, lower-cost alternatives on the formulary when appropriate.

Members may be unaware that the drug they are taking has such a low clinical effectiveness rate compared to other drugs available to them. And prescribers may be unaware of the true cost of the medication they are prescribing as compared to available alternatives. By building upon your clients’ selected drug formulary, excluding high-cost medications with low clinical value ensures that they are not overpaying for prescription drugs.

Myth 3: Managing my client’s pharmacy plan would cause too much noise from their members.
Busted! Clinical strategies tailored to the plan’s specific risk areas can generate savings of 7-10% with minimal member impact.

The fact is that the majority of pharmacy costs are being driven by an average of 0.5% of members. This means that your clients can maximize their clinical oversight and savings opportunity without disrupting a large portion of their membership. Using advanced data analytics and forecasting, your clients can review the potential savings and member impact before deciding to implement a clinical strategy. Having a plan in place to proactively communicate the prescription review process to the affected members will help them understand what to expect before they get to the pharmacy.

To learn more about how clinical management strategies can help your self-funded employer clients, download our free pharmacy benefits ebook, Building an Optimized Clinical Playbook.