Prescription drug benefit design: the building blocks and their impact on cost.

Before changing plan design to address the problem of rising prescription drug benefit cost, employers must understand and periodically revisit the pharmacy benefit building blocks. Ultimately, aligning all aspects of the pharmacy benefit is the best and only way to help control drug benefit costs and, at the same time, promote greater employee satisfaction. This article describes how the pharmacy benefit building blocks of delivery (dispensing), provider contracting, drug products and benefit design all have to work together to produce a more effective pharmacy benefit program.

Beyond the myths: finding benefit design solutions that address the true costs of high healthcare use.

Chronic and severe health problems place an enormous financial burden on individuals, employers, and health plan providers, requiring all to make tough decisions about healthcare. Specialty pharmaceuticals are increasingly attractive treatment options, but employers need tangible ways to incorporate these medications into benefit plans. Benefit managers can take a proactive role in addressing cost and compliance issues, using evidence-based data about true patient costs to develop policies that encourage employees to seek appropriate care. Achieving savings in direct and indirect costs will require more than shifting coverage, which can lead to nonadherence and increase costs elsewhere.