Support Tools for Members in High Deductible Plans

Jul 24, 2019

Express Scripts provides comprehensive insights, including predictions of out-of-pocket spend, to help members optimize use of the pharmacy benefit, particularly for members enrolled in high-deductible health plans.

New Pills

Recently, the Internal Revenue Service issued new guidance, effective immediately, that expands the list of preventive care benefits permitted to be provided by a high-deductible health plan. This allows patients with high-deductible plans easier access to coverage for treatments related to their chronic illnesses by ensuring their plans cover low-cost preventive-care services, such as insulin or inhalers, before they meet their deductible.

We welcome this decision, recognizing preventive medications and care benefits are essential to reducing the risk of worsening conditions and lowering overall healthcare costs.

How We’re Helping Members Plan for Health Care Costs

Americans’ out-of-pocket costs for prescription medications rose to $61 billion in 2018, nearly 18% of the total $344 billion spent on prescriptions in the U.S. last year. While health care expenses are increasing year-over-year, few resources are available for patients seeking insights into how these costs will impact their ability to afford care. Pharmaceutical and medical records can be difficult to acquire, so preparing a budget or finding alternative ways to lower costs can be difficult. This acutely impacts members enrolled in high-deductible plans, also known as Consumer Directed Health Plans (CDHPs), who are responsible for the full cost of care until the deductible has been met. This often leads to sticker shock. To help members better plan for their health care costs, Express Scripts has developed a tool, Prescription Benefits Review.

Better Planning, Better Health Care Choices

We know that higher prescription costs can lead to lower adherence rates and increased downstream health risks, particularly with the CDHP population. By arming members with their Prescription Benefits Review (PBR) statement, we’re helping members better plan for future health care costs by delivering personalized pharmacy spend reports, forecasted out-of-pocket spend and available savings opportunities.

Because members enrolled in CDHPs often lack insight into what they can expect to spend, this may limit their ability to adequately plan and budget for future health care expenses. In order to close this gap, we have developed a proprietary algorithm that is able to forecast a patient’s future spend. Now, with both their full prescription history and estimated future costs in tow, members may successfully navigate previously unforeseen financial burdens and make better care decisions. What was previously an unknown, is now a helpful tool to assist in financial planning for the future, whether that be contributing to a Health Savings Account (HSA) or setting aside a monthly allocation.

Additionally, the reports stimulate member education by consolidating their prescription expenses into an easily digestible format, referenced below.

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Providing a look into prescription history in this format can help members become more financially prepared health care consumers. By providing a detailed prescription cost breakdown, the member can view their plan sponsor’s direct contribution toward their pharmacy care alongside their own contributions. Such insights help members make more informed and fiscally conscious decisions when choosing their benefits for the following plan year.

Member-Focused Cost Savings

Through Prescription Benefits Review, members are encouraged to take advantage of savings opportunities. Where possible, members will find a listing of cost-effective alternatives under their current prescription benefit, which also includes home delivery and 90-day fill options. This enables meaningful dialogue between members and their prescribers about their direct pharmaceutical costs. Another benefit of these cost-savings opportunities is that the PBR may positively influence adherence by proactively giving members options to make their medication fills more affordable and more convenient. The example below depicts how savings opportunities are shared with members.

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Additionally, members can now elect to receive their PBR statements digitally. Through simple online registration, their statement is sent to their designated email address. History is retained for up to 18 months, making the statements a handy tool when preparing to file taxes and other financial reports.

PBR is a unique benefit as it empowers members to become more financially savvy consumers by clearly outlining their current pharmacy expenses, providing a forward looking view of anticipated future spend, and arming them with actionable recommendations to help lower their health care costs.

Author Bio

Sarah Stremlau
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