Bitter pill Featured

10:45am EDT July 21, 2004
Not long ago, most employers looked upon their prescription drug plans as simple and benign benefits, less likely to cause unrest than their annual company picnics. Today, however, drug coverage is demanding 15 percent or more of an employer's health care dollars, and the cost of it is rising faster than that of any other benefit.

We all know the reasons. Impressive new drugs reach the market each year, treating a wide range of ailments. Massive ad campaigns support these drugs, driving consumer demand as patients ask doctors for specific prescriptions. Drug utilization on the whole also is increasing, due in part to the growing population of older adults, who use three times as many drugs as younger people.

The result? A nation that, according to the Alliance for Health Reform, went from spending $12 billion on drugs in 1980 to spending nearly $122 billion by 2000. And experts project that spending on prescription drugs will continue to increase an average of 11 percent annually through 2008.

In response to these challenges, many employers are taking advantage of an increasingly broad and sophisticated set of tools to manage their pharmacy benefits programs. To get the most value from your plan, and to help promote the health and safety of your employees, you might consider taking advantage of some or all of these programs.

Identifying diseases early

It's vital for individuals and their physicians to manage treatment for conditions like asthma or heart failure very carefully. Patients who make positive lifestyle changes, use medications correctly and stay alert for symptoms have a better chance of staying well longer and avoiding hospital visits.

By analyzing pharmacy and medical data, a health insurer can help physicians identify plan members with certain chronic health conditions who could benefit from disease management programs. In essence, these programs help employees get the right medications and counseling to avoid potentially serious -- and costly -- conditions in the future.

Reducing drug-related health risks

By mapping employee pharmacy and medical data against medical histories, a health plan's computer system can help physicians and pharmacists minimize harmful interactions between certain medications and conditions, helping your employee avoid a dangerous and costly medical issue.

When a potentially dangerous interaction is found, many insurers proactively send a message to the pharmacist, who then uses professional judgment or contacts the employee's physician to discuss the situation. Similarly, these systems help health care providers protect your employees from many kinds of prescribing errors by flagging recently covered prescriptions that could cause severe adverse interactions with other drugs they may be taking.

Investigating step therapy

The newest drug on the market may not always be the most appropriate treatment for a given person's condition, but it often is the most expensive. "Step Therapy" programs encourage physicians and patients to explore effective and efficient medication options that may be available before trying therapeutically equivalent, more costly alternatives.

Leveraging mail-order pharmacies

For many short-term prescriptions, it makes sense to run to the local pharmacy. But mail-order pharmacy programs are great for employees who take certain medications on an ongoing basis.

Prescriptions can generally be ordered via phone, mail or Web, and are delivered right to the home. Depending on the benefit plan, the mail order program can save money for the employee and the company.

Educating employees about generics

Your health insurance company should be able to provide information about ways you and your employees can maximize the value of your benefit plan. For example, on average, generics cost 50 percent to 75 percent less than brand-name drugs. Accordingly, encouraging appropriate generic drug use can significantly reduce your plan costs.

While you may not be able to take advantage of every one of these programs, each offers a unique opportunity to leverage your pharmacy plan to promote improved employee health and keep a lid on escalating costs. Your insurer or broker should be able to provide more information and ideas about making your drug plan an easier pill to swallow.

Thomas J. Scurfield is the vice president of sales and marketing for Aetna's east central region, based in Cleveland. He has more then 25 years of experience working in employee benefits and holds both the Chartered Life Underwriter and Certified Employee Benefit Specialist designations. Reach him at (330) 659-8020 or