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Mercer

With all the uncertainties around healthcare legislation swirling, cost control of pharmacy spend remains top priority for employers. On one hand, employers obviously want their employees to have access to the medications they need: drugs like insulin, blood pressure treatments, and cholesterol blockers have long played a critical role in employees’ health. But now new specialty biotech drugs – some of them true medical breakthroughs – are flooding into the market, at costs much higher than previous therapies. Drug prices spiked by 9.8% between May 2015 and May 2016, and there are more sharp increases ahead. Drug costs are quickly becoming unsustainable, for both employers and, increasingly, plan members. Many high-cost brand name drugs may have rebates to reduce their net cost, but the member or patient typically does not see these rebates so their out-of-pocket cost is still high. And even the cost of some generic drugs has risen dramatically.

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Check out this article for tips on managing out-of-pocket expenses in a high-deductible health plan. Typically, your paycheck deductions are lower, which is a bonus, but how do you keep from falling behind financially when you need care? Here are the author’s suggestions, plus a few from me.

  • Take advantage of preventive services covered at 100%. For example, get a flu shot so you are less likely to get sick.
  • Use in-network providers for the lowest possible out-of-pocket expense.
  • Consult with a nurse for free by calling the nurse-line for a consultation before scheduling an appointment with a physician; it could save you the cost of an office visit
  • Many plans include a telemedicine benefit. The cost of a telemedicine visit is usually around $40-$50, and can be scheduled at your convenience via phone or video chat.
  • Investigate "convenience care” clinics in your area. Located in stores like Target, CVS, and Walgreens, they offer a limited number of services at a lower cost than urgent care or a physician office visit.  
  • When your doctor recommends a prescription drug, ask how much it costs and if there is an over-the-counter or generic option. Check a few different pharmacies for the best price. 
  • If a prescribed drug is very expensive and you have not used it before, ask whether you could have a smaller number of pills at first to be sure it works. Check to see if there are patient assistance programs to help defray the cost.
  • Shop around for services and tests. A variety of tools exist to support comparison shopping; check with your insurance company for help.
  • Some employers offer indemnity coverage -- policies that will pay a set dollar amount when you have an accident or are hospitalized. These low-cost coverages can provide peace of mind for those concerned about covering expenses before they meet their health plan’s high deductible.
  • If you’ve moved to the high-deductible plan from a more expensive plan, take the savings from lower paycheck deductions and deposit them (tax-free!) in a health savings account. That way you will have some money set aside to help pay for care before you meet the deductible. Many employers will help fund your HSA.  
  • Take advantage of any opportunities to earn dollars for your HSA by participating in healthy activities like biometric screenings. 

These are good suggestions to communicate to employees and their families. Even if you have provided similar guidance in the past, everyone can always use a refresher.

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