Unhealthy Behaviors Worry HR Managers | Express Scripts

May 17, 2012
We conducted a national poll to uncover which trends are top-of-mind for Rx plan sponsors. Leading the list: helping members make healthier decisions.

During the 4th quarter of 2011, we commissioned a national study on prescription benefit management trends. Polling 318 plan managers from leading corporations, nonprofit organizations, labor and public sector groups, we sought their perspectives, opinions and insights on:

  • Trends in prescription benefit philosophy
  • Current and future approaches to controlling prescription costs
  • Impact of healthcare reform (PPACA)
  • Specialty medications, home delivery pharmacies, generics, integrated data, and wellness management
  • Coverage for Medicare-eligible retirees
  • Shifts in priorities as plan sponsors continue to evaluate their options

What emerged from this research are 9 trends that represent what’s top-of-mind for those responsible for providing pharmacy coverage for millions of Americans.

Leading the list of trends: helping members make healthier decisions. Poor health decisions add billions of dollars in costs to benefit providers. In fact, more than 75% of plan sponsors say behavior-driven conditions are the greatest contributors to plan costs. The decisions that plan members make – or the actions they don’t take – can lead to medication waste, unnecessary hospitalization and an overall decline in wellness and productivity. Choices clearly matter, and suboptimal health outcomes are making it harder to provide a robust pharmacy benefit.

In response, plan sponsors are investing as never before to combat the issue, and a vast majority are now focused on improving the health behaviors of their members.

Integrated pharmacy/medical data is likely to play an increasing role in identifying members at risk, and enhancing coordinated efforts with disease management and wellness vendors. At least three-quarters of respondents say they intend to employ integrated data programs, such as RationalMed®, to support these initiatives within the next two years.

Other leading trends featured in the report include:

  • Using social media and apps to engage members and improve behaviors
  • Improving adherence and convenience through home delivery
  • Developing new ways to comprehensively manage specialty care
  • Understanding the impact of healthcare reform on future coverage options
  • Leveraging the benefits of Employer Group Waiver Plans (EGWPs) in place of Retiree Drug Subsidies (RDS)
  • Revisiting consumer-directed health plans to encourage member self-reliance
  • Addressing the impact drug company coupon programs have on generic utilization

Watch this space during the next few weeks as we explore these other trends and have more in-depth conversations on these important topics.

In the meantime, you can find additional insights by visiting http://www.9trendsreport.com/pr.

Author Bio

Tim Wentworth
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