Some employers have called prescription drug benefits the “black hole” of company-backed health plans, with costs escalating despite years of efforts to bring them in check.
A group of large self-insured employers from the region gathered last week with health care executives and leaders at VUMC to take on the topic of prescription drug spending and look for opportunities to collaborate on solutions.
It was the latest Employer Roundtable at Vanderbilt, which was held at the Student Life Center. The event provides a forum for leaders to tackle complicated topics related to employee health benefits strategy, delivery and management.
“The goal of this Employer Roundtable is to start a dialogue or continue a dialogue about the challenges that we’re all facing as employers, as providers,” said Mark Cianciolo, executive director of Vanderbilt Health Affiliate Network (VHAN).
The roundtable featured a panel of health care and human resources leaders from Vanderbilt and outside of the institution.
At the same time that employers have attempted to rein in spending on prescription drugs in recent years, more and more expensive new drugs have hit the market, Cianciolo said.
The discussion of prescription drug benefit spending included a focus on the role of the specialty pharmacy, which is charged with providing prescription drug services for costly and highly complex medications.
Pharmaceutical companies and health care payers designate roughly 5 percent of prescription drugs as specialty, some because they are very high maintenance and require more patient follow-up, some because they are subject to post-marketing safety monitoring imposed by the FDA, and some because of their great expense.
This year, an estimated 50 percent of all new drugs to be released will have the designation. The increased cost of the drugs has been part of what has driven up employer spending on prescription drug benefits for employees.
David Posch, associate vice chancellor for Population Health, said while prescription drug benefit spending is set to continue to rise in the years ahead, there is great opportunity for employers to improve the health of their workers and ultimately bring down costs through the use of pharmacy services that use a more hands-on approach.
He pointed to the high number of patients who die each year from failing to comply with prescribed drug therapy treatment plans — patients who don’t fill the prescription, don’t take the drug properly or understand why it was prescribed.
“The real issue is not just making sure patients have the right drug at the right time, but also how are we engaging the patient populations relative to the drug therapy itself,” Posch said.
For employers, the key to managing prescription drug benefits is not just scrutinizing how much they spend on generic versus name brand or specialty drugs, but rather patient compliance with the therapy, Posch said.
That’s especially true for patients with chronic diseases, he said, which also accounts for a significant portion of employer health care costs.
In a bid to bring down those costs, employers through the years have tested a range of payment models of providing health insurance, moving from plans that cost workers little or nothing to plans that shifted more of the burden to employees, Posch said.
The broad theory behind the shift was to encourage the employees to be wise consumers when using health care services, Posch said.
“I’ll submit to you that that is counter intuitive when we’re dealing with chronic disease,” Posch said. “Because when we’re dealing with chronic disease, we don’t want to discourage the use of health care. We want to encourage the appropriate use of health care. We want to encourage compliance to drug therapy. It’s really important that if someone has hypertension, they reliably take their medication and get checked.
“I’m challenging all of us to rethink the financial formulas around this and say there are times when you want to remove that copayment and deductible and say, ‘Go get the medication and take it reliably. It is to your benefit. It is to our benefit as an employer,’” Posch said.
