This article is primarily intended for self-funded, large groups in Iowa and South Dakota.
Let’s skip the jargon and get straight to the point: Pharmacy costs continue to rise, and trying to merely control them is no longer a viable strategy. A multi-pronged approach — like offering a more managed drug list, limiting your network and combining medical and pharmacy benefits — can positively influence the health of your employees and your bottom line.
The cost and usage of prescription drugs are rapidly increasing pharmacy dollars. In fact, it makes up almost 25 percent of Wellmark Blue Cross and Blue Shield's annual health care spending. Prescriptions and medical services are undeniably intertwined, which makes managing them together a wise decision.
By combining medical and pharmacy benefits, you can gather constructive insights into care coordination while lowering medical costs without raising pharmacy spending. This holistic approach to health care results in:
Four percent lower emergency room visits, nine percent lower hospitalization events and eleven percent lower per-member per-month medical costs.
So what’s driving the costs? Within pharmacy, there are three main factors:
- The cost of the drugs themselves
- The drug mix — whether members are using more or less costly products
- Utilization, which encompasses how many people take a drug, how much drugs cost, and the quantities associated with these prescriptions
While the first one is largely outside of our control, we can affect the other two drivers to make a measurable impact on pharmacy trend. And by choosing Wellmark for both medical and pharmacy benefits, you can tap into the power and efficiency of our national program that maintains our independent oversight.
- Local management provides your employees unmatched access to pharmacies through our comprehensive network. We’re able to get even greater discounts, which we pass back to you, by leveraging our 2 million members.
- Expert evaluation by the Pharmacy & Therapeutics (P&T) Committee Opens in a new window, which consists of local doctors and pharmacists that select medicines based on safety and effectiveness, not just cost.
- Independent channels keep your costs as low as possible. We divide pharmacy management into three cost-saving components: pharmacy benefits, specialty drug and mail order.
The difference is in the details
By managing your medical and pharmacy benefits together, you can positively impact your overall health care — both costs and experience.
|Wellmark Pharmacy Program||Other pharmacy benefit managers|
|Pharmacy leveraged alongside medical to reduce overall health care expenses||Pharmacy managed separately, which can lead to increased costs on the medical side|
|Specialty drugs managed on both medical and pharmacy benefits for coordinated care||Specialty drugs disconnected between medical and pharmacy leading to potentially negative patient experience|
|Full disclosure of price points for greater insight and transparency||Opaque pricing can lead to confusion of true costs versus pharmacy benefit manager profit|
|Designed to promote safe, high-performing, cost-effective drugs for efficient care||Designed to chase rebates offered by drug manufacturers that can inflate total spend|
|Holistic look at total cost of care for greater understanding of your health care usage and trend||Focused on pharmacy costs only, which can inadvertently increase medical costs|
|Aligned with your needs in managing health care costs without sacrificing safety and effectiveness||Aligned with profits, lowering overall value to you and your employees.|
As part of an ongoing series, we’ll look into the different ways to positively impact pharmacy trend, sharing insights and tips along the way.
We know that pharmacy, and the costs associated with it, continue to be top of mind. Keep up to date on the latest insights, resources and more Opens in a new window from our pharmacy experts. Or, email us at firstname.lastname@example.org Send Email, and we'll connect you with a Wellmark representative to learn more.