Apr 12, 2023
Rising drug prices are creating challenges, but a whole-person, integrated and collaborative approach can save money and bolster better health outcomes.
It’s a safe bet that, in 2023, employers and employees will spend even more money on prescription drugs than they have in the past due to the current economy. In fact, drugmakers started the year by raising the prices of 450 products, with the expectation that more price hikes are to come. Total drug spending increased 7.7%, to $576.9B in 2021, and a further rise of around 5% was the projection for last year.
Drug prices are so extraordinarily high and contribute so much to the cost of health care that employers are now in a position where they have to make more difficult choices about how to spend their money. Some of those decisions could include shifting costs to employees, raising deductibles or even ending coverage entirely for certain drugs. But thoughtful cost-management strategies can help provide crucial relief for both employers and their employees.
The good news for employers and employees alike is that lowering pharmacy costs is possible with a multi-pronged strategy. At UnitedHealthcare, the right approach involves integrating medical and pharmacy benefits, collaborating across the health system and launching new initiatives that have the potential to save money and improve health outcomes while delivering a better experience.
Integrating Pharmacy and Medical Benefits
Less-than-optimal treatment decisions are more likely when a patient does not have integrated medical and pharmacy benefits. An example involves 2 different HIV prevention medications, each offering the same protection from HIV:
- A $20,000 per year shot a health care provider administers every other month in the office; or
- A $2,000 per year generic daily pill picked up at the pharmacy
Someone with separate medical and pharmacy benefit carriers may end up receiving the $20,000 shot, because their carrier and pharmacy benefit manager (PBM) are not synced up on how to manage treatments that have options under both benefits.
Value-vetting is at the core of integrated benefits. Any specialty drug that comes to market is screened to ensure that it’s safe, effective and delivers tangible value in line with the price charged by its manufacturer.
Collaborating Across the Health System
As the variety and complexity of possible treatments grow, the potential for collaboration across the health system to reduce costs and expand access grows.
UnitedHealthcare's Cancer Guidance Program (CGP) is an evidence-based treatment management and analytics service used by UnitedHealthcare to help ensure quality care and reduce costs. CGP directs oncologists to prescribe the highest-quality, most cost-efficient treatment regimen option, while also helping them quickly obtain authorizations. UHC reports a 10:1 return on investment for employers leveraging the CGP.
Another example is UnitedHealthcare PreCheck MyScript® in which prescribers get prompted when there is a lower-cost drug alternative, saving employers an average of $285 per switch and employees an average of $111 per fill when a lower-cost alternative is selected, based on Optum Rx's analysis of 2021 claim data. Optum Rx, the pharmacy care services company within Optum — an affiliate company of UnitedHealthcare — introduced a new tool this year that takes it a step further, empowering employees themselves to compare prices for traditional generic drugs based on their insurance coverage.
These collaborations are becoming increasingly common and are necessary to change the trajectory of pharmacy care costs.
Launching Groundbreaking Initiatives
If people can’t easily afford the medications they need, they’re less likely to take them, which contributes to poor health outcomes.
As part of its commitment to affordability, access, equity and innovation, UnitedHealthcare was the first in the industry to eliminate all out-of-pocket costs for 5 vital medications for eligible members: insulin to treat diabetes, epinephrine to treat allergic reactions, glucagon to treat hypoglycemia, naloxone to treat opioid overdoses and albuterol to treat acute asthma attacks.
Some of the emergency-use drugs covered by the new $0 out-of-pocket policy — which applies to about 8.3M members — might otherwise cost hundreds of dollars.
Prescription Drug Lists (PDL) and utilization management programs, including prior authorizations, are also helping manage the costs of some of these drugs. UnitedHealthcare PDLs, for instance, are built to incentivize employees to use covered, clinically appropriate and cost-effective medications.
Waiting for a prior authorization to get approved can be frustrating for employees. So, for certain drugs, the company has streamlined the process, such as automatically approving or removing prior authorizations altogether for certain drugs based on an employee’s pharmacy and medical claims data and diagnosis information.
Learn more about how UnitedHealthcare is helping manage health care costs, or contact your Amwins Connect Regional Sales Manager for more information.
