Developing Goals for Your Self-funded Prescription Drug Benefit
It makes sense for Human Resources VPs and Plan Managers to develop specific objectives related to the management and administration of their employee prescription drug benefit. This article identifies ways MedImpact consults with self-funded clients to help them develop goals, understand the occasional trade-offs, and collaborate to achieve these goals.
What should your goals be?
Begin with your organization’s broad goals, and then determine how proper management of the prescription drug benefit can contribute to achieving them. For example, MedImpact has a hospital system client who had set a broad organizational goal of becoming paperless. We helped the Benefits Department contribute to that goal by feeding formulary and compliance data directly into the electronic medical records of hospital physicians treating their employees. The result: better care for members ─ and less paper. Virtually all MedImpact self-funded clients have three drug benefit goals in common:
- Enhance member experience with the plan
- Improve the health of members
- Manage Rx costs
In a perfect world, fully achieving these goals would mean the following:
Enhance Member Experience: Every member would understand their drug benefit, comprehend its value, have good access to pharmacies, and have access to experts who would answer their questions quickly and competently.
Improve Member Health: Every member would be taking their medication exactly as directed; they would not be at unnecessary risk for any drug-to-drug interactions, and they would be making lifestyle changes where appropriate to improve their wellness.
Manage Rx Costs: Every member would be on the lowest-cost appropriate medication for their condition; they would get that medication from the lowest-cost distribution channel, and there would be zero waste.
How do we achieve them?
MedImpact Account Executives (AEs) and Clinical Program Managers (CPMs) take a holistic approach to helping clients achieve their goals. They first identify the opportunities to enhance the member experience, improve population health and achieve lower costs. Then, they identify specific programs designed to change behavior that will best achieve those results. Often these programs utilize multiple ”touch points” to change member behavior. For example, a member may be reached through direct communication in addition to being reached through their physician and pharmacist. By employing these multiple touch points, member behavior is more likely to change. And unlike other PBMs that have a financial incentive to drive members to the PBM’s own pharmacy, MedImpact can apply these programs to change behavior regardless of the pharmacy the member uses.
Can there be conflicts between goals?
There are many cases where making changes to achieve one goal ─ cost savings, for example ─ may conflict with another goal, such as enhancing member experience. For example, implementing a preferred or limited pharmacy network may result in member disruption in exchange for achieving cost savings. Or, implementing step therapies on certain drugs (in which a member is required to first try a less expensive therapeutically equivalent drug prior to being allowed to get a more costly version of the drug) can result in savings for the plan while potentially causing confusion among members and their physicians.
The key to minimizing the trade-offs between cost savings and member experience lies in proper communication to members and, when appropriate, their physicians. In the step therapy example above it is very likely that, with proper communication, a member and their physician would better understand the potential long-term benefits of a step therapy program designed to offer effective drugs that are therapeutically equivalent but at a lower out-of-pocket expense for the member.
If you haven’t had a conversation with your MedImpact AE to share your organization’s goals and identify the specific goals for your prescription drug benefit, I encourage you to do so. Your AE can guide the process and ensure MedImpact is focused on meeting your needs.
Kurt Laycock
Regional Director, Self-insured Account Management