Important RX Trends

What should we be watching for in the pharmacy market?

Many employers prefer “no disruption” to their health plan. That means no provider changes in the PPO, no changes to the drugs on “the list”, etc. This is simply not going to happen. No matter how much you dislike it, the market is changing around you.

The list of available drugs in the market is constantly changing. Even if a plan wanted to stand still with no change, they would be unable to because of these facts:

  • More drugs are becoming available as generic
  • Specialty drugs are becoming more widely used for multiple conditions
  • Bilogics are a costly trend that must be effectively managed, and they create strong ethical questions that demand judgement.

You need to plan for “good disruption” and the right changes to your plan.

Consider this:

These are the generics likely to become available during these two years. You must decide how your plan will cover them, or if they will cover them.

Generally speaking, this can mean lower cost to your plan. But not if you are with a PBM that is not promoting lower cost alternatives—and there is a good chance you are spending too much money now!

Contact us for a Claims Replay today to see how much you will save.