If a company is struggling with rising drug costs, one guaranteed approach to reducing costs is to have all members on the plan stop taking their medications. An immediate reduction in drug spend is inevitable. Although this is a very effective approach to reducing drug costs for any company, it is certainly not viable nor beneficial. When we evaluate drug costs as a silo in the health care system, many organizational leaders focus only on reducing drug costs without taking into consideration the implications of drug costs on the overall health care spend.
However, one perspective may be commonly overlooked…
Increasing drugs costs may likely reduce overall health care costs. An appropriate and well-managed investment into drug spend can reduce health care expenditures.
For example, patients choosing to take their cholesterol or diabetes medication every other day to reduce their own costs will reduce drug spend but could increase overall health care costs. By improving medication adherence, the overall drug or medication costs are going to increase. The trade off is the better management of the cholesterol or diabetic patient that may lead to a reduction in unnecessary physician visits or hospitalizations. Studies have shown that if employers or health plans have well-designed medication management programs in place, patient adherence improves and overall health care costs are reduced…. even when drug costs increase. It is important to note that automatic refill programs do not ensure medication adherence. It is a tool to improve adherence, but medication adherence can really only be evaluated through patient engagement with a pharmacist or other health care professional.
Rather than simply monitoring drug costs on the plan, evaluate overall pharmacy plan management and its value. Ensure that formulary decisions are going to bring cost-effective outcomes that improve health and reduce overall costs. Ultimately, a well-managed formulary coupled with a pharmacist-run medication management program will likely result in optimized cost-mitigation.