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  • David Steinberg, PharmD JD

5 pharmacy benefit insights to share with employees during open enrollment (As Seen In BenefitsPRO)

As an HR professional, you’re constantly looking for ways to improve your employees’ experiences and provide them with the best benefits. While you work year-round to offer benefits that help employees save and encourage them to feel empowered to make the right health decisions, it’s important that you arm yourself with the right information and tools as open enrollment season approaches and your employees come to you with questions.

Most companies end up designating around 30% of their benefits spend to prescription benefits. Over the years, prescription drug spend in the U.S. has skyrocketed, and in 2020, it was at an all-time high at more than $350 billion.

A survey from Scripta Insights even found that despite having health insurance, 66% of people think they pay too much at the pharmacy counter. With this in mind, there’s no surer way to have unhappy plan members than to have their prescription prices suddenly change or no longer be covered with a new plan year.

As a PharmD, and the Director of Pharmacy Insights at Scripta, I’ve outlined the advice you need to get ahead of the most common concerns your members may have about their pharmacy benefits:

1. Location, location, location: No one likes to be inconvenienced when filling a prescription. Just like medical insurance, pharmacy benefits come with “in-network” and “out of network” pharmacies. Each plan has specific pharmacies where a member must fill their medications. Check with your plan so you can provide your members with the most accurate information to avoid a trip to the wrong pharmacy.

2. It pays to know the tiers: Copays used to be simple, but now plans are becoming more customized and company-centric with new tiers added and changes made year-to-year. Your PBM should be able to provide your members with a “cheat sheet” that breaks down your plan’s different levels and expected copays so there are no surprises at the pharmacy counter. Some PBMs will even provide a wallet-size cardmembers can take to their doctor and pharmacy.

3. There’s an app for that: Every PBM and insurer has an app with your members’ insurance cards, benefit lookup, local physicians, urgent cares and FAQs. Direct your members to the app to improve their benefit experience. Be sure to communicate that the app is secure, and their information is protected, to get ahead of any member privacy concerns. If your members are using the app, HR won’t be the first place for questions, which also frees up your team’s time and helps improve productivity.

4. Don’t miss out on savings: Coupons are not just for groceries anymore. Digital prescription savings cards are available through various apps, sites, as well as directly from drug manufacturers. This is a great way for your members to save on brand and specialty medications, reducing their out-of-pocket costs. You might also consider adding a prescription savings benefit to your plan. These third-party vendors may review your members’ recent prescriptions and recommend lower-priced, clinically equivalent alternatives based on your insurance plan.

5. New Year, new deductible, new out-of-pocket expenses: For most companies, Jan 1 (and July 1) brings a new plan year, which also means deductibles reset. During the first quarter, HR often gets bombarded with questions from members who forget that medications, too, fall under deductibles. It’s important to remind members that they will pay the full cost of a drug until they meet their deductible.

Navigating the complexities of pharmacy benefits and always-changing drug pricing is not something HR pros should have to face on their own! There are a number of resources available that can help make your life easier. Work smarter, not harder!

Arm yourself with the right information and tools so your members can be happy, stay healthy and keep more of their hard-earned money.

As seen in BenefitsPRO.


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