Pharmacy costs have continued to rise over the last 10 years, with spend shifting to high-cost brands and specialty medications. Now 1% of claims are driving 40% of the cost for most plans, causing drug spending to feel like its spiraling out of control.
As an employer, did you know that you have some control over pharmaceutical cost drivers? While there are some things that cannot be controlled, there are manageable risk areas that, when managed correctly can positively impact your plan. These areas include:
- Paying for drugs with questionable clinical value
- Inappropriate dosing
- Inappropriate utilization
- Off-label prescribing
- Copay cards for higher-cost drugs that negatively affect plan cost
Employers can close in on clinical gaps by using data analytics to zero in on cost-drivers that pose the greatest risk to the plan.
It is possible to manage a pharmacy program clinically. To do so you need to have clinical management programs in place with the purpose of reviewing appropriate use, ensuring that you are not spending valuable plan dollars unnecessarily.
Do you have questions about how to make sure you and your employees are getting the most out of your plan?