With healthcare costs on pace to increase by 8% in 2024 – four times the rate of general inflation over the next four years – it’s no surprise that Aon’s 2024 U.S. Health Survey found employers’ top priority is to manage health plan costs. A Benefitspro.com article on the survey highlighted four key strategies that employers can use together with the right PBM partner to help control these rising costs:
1. Drive healthcare quality and value through value-led strategies that encourage the use of high-quality and cost-effective care
Value-based pharmacy care that emphasizes patient health outcomes and reducing actual drug costs over the immediacy of volume-driven rebates supports the long-term health and viability of the sponsor’s plan. Using a clinically-driven PBM model, clinical pharmacists can attack the drug cost problem “at the pen,” when the physician writes the prescription. For example, EmpiRx Health’s pharmacists collaborate with prescribers to suggest clinically-appropriate, evidence-based changes to drug therapies, frequently recommending lower-cost medications or dosing and regimen changes and optimizations.
2. Manage high-cost claimants with a focus on clinical programs and audits
No two patient populations are the same, and with 1-2% of patients accounting for half of the total prescription spend, each population requires tailored solutions to best serve a plan sponsor’s specific membership. In a clinically-driven PBM model, AI-powered population health technology and risk stratification enables clinical pharmacists to identify patients who require a higher level of care and recommend the most appropriate and cost-effective drug mix, prioritizing health outcomes.
3. Double down on managing the cost of prescriptions, with specialty drugs and weight loss drugs driving pharmacy cost increases
Using outcome-based contracts with PBMs and drug manufacturers is a key factor in controlling costs through a pay-for-performance model. Savings should be guaranteed due to a value-based, clinically-driven model that focuses on patient health outcomes, including utilizing open pharmacy networks and formularies that prefer specialty drug biosimilars and generics. This clinically-driven approach is a game-changing departure from the legacy PBM model that prioritizes volume-driven rebates.
4. Adopt technology and personalization by embracing new technology in areas that manage chronic conditions
AI-powered population health and predictive modeling technologies help clinical pharmacists proactively identify and conduct clinical reviews of patients who require a higher level of complex care. Allowing the pharmacist to collaborate with the patient’s prescriber ensures that they’re receiving the right medication, at the right time, at the right dose – optimizing patient health outcomes and reducing drug costs.
If you’re like the 38% of survey respondents who ranked managing healthcare costs as their top priority for 2024, choosing the right PBM partner is essential. At EmpiRx Health, we’re uniquely positioned to help you execute these strategies using our clinically-driven and value-based model, backed by a clinical savings guarantee.
