A certain forecast: health consumers will be more cost-squeezed in 2014 for Rx and insurance

Therapy Adherence Outreach MethodsGird your wallets, U.S. consumers: watch the dollars flow out-of-pocket for prescription drugs in 2014, as predicted by the 2013-2014 Prescription Drug Benefit Cost and Plan Design Report published by the Pharmacy Benefit Management Institute (PBMI) this week. Constraints covering most plan members are:

  • Step therapy
  • Prior authorization (to get approvals to fill high-cost drugs, notably growth hormones, injectables, controlled substances, Retin-A, and medications for sleep disorders, and
  • Compulsory 90 day refills at retail (90-day dispensing for chronic meds).

This Report, sponsored by Takeda, is the gold standard of drug benefit trends, having been published since 1995.

Average 30-day copayments for 3-tier Rx plans (which cover two-thirds of employees vs. 2- and 4-tier plans) for generic, preferred brand, and non-preferred branded drugs are $11, $30-32, and $56, respectively. Specialty copayments average $107, ranging from $40 to $275. Coinsurance percentages for nonpreferred brands at retail 30 days as well as mail average 39%.

This cost-sharing is being coupled with medication adherence – drug plans working to nudge patients to take their prescribed drugs at the right dose, right time. The first graph shows that the most common form of outreach for Rx adherence is via mail, with 7 in 10 plans using this Old School communications method. Mail is followed by ‘live’ pharmacist intervention and live phone calls, used by 65% and 57%, respectively.

Mobile methods, like test/SMS messaging and mobile apps are used much less frequently for medication adherence management, with 12% and 11% shares.

The survey among 478 U.S. employers was done in March-April 2013. Together, the companies polled represent 22.5 million plan members.

Gallup poll 30 percent of people denying hc due to costs Dec 13Health Populi’s Hot Points:  PBMI characterizes the trends from 2013 into 2014 as “holding steady,” saying that the advent of health insurance exchanges (public and private), mandatory coverage provisions in the ACA, and the list of essential health benefits in the law have stalled big changes in drug benefit planning.

But peoples’ wages are static and so in fact consumers aren’t holding steady – they’re self-rationing, according to Gallup’s latest poll finding that costs are keeping 30% of people in the U.S. from getting health care. That self-rationing is shown in the first chart.

Gallup poll - serious conditions

What’s confounding and more concerning is that the

According to the 2013 International Foundation of Employee Benefit Plans Employer-Sponsored Health Care: ACA’s Impact Survey, more employers are increasing workers’ share of premium costs, increasing the employee portion of dependent coverage costs, increasing in-network deductibles, and increasing out-of-pocket limits.

Expect more self-rationing in 2014 as people take on more costs, but don’t yet cotton onto how to deal with high-deductible health plans, save money in health savings accounts, and prioritize other household spending like food, energy, clothing, and technology purchases.

The opportunity for mobile tactics, like texting and SMS, and mobile apps, is ripe. Mail and pharmacist interventions don’t flow well into peoples’ everyday lives, 24×7: they are one-time, intermittent strategies. So while some people are pondering not filling the prescription, opting out of paying for it, as Gallup suggests is happening (confirmed in the Kaiser Family Foundation’s Health Tracking Polls of consumer behavior in the post-recession health economy), mobile communications can help reverse this trend and move people to do the right thing by their prescription drugs. This report finds that this could be a missed opportunity for the next year for both pharma manufacturers who could benefit from more filled scripts over time, and patients whose health outcomes could be improved by sticking with prescribed medication regimens.

 

3 Responses to A certain forecast: health consumers will be more cost-squeezed in 2014 for Rx and insurance

  1. Laura Henze Russell February 25, 2014 at 5:53 pm #

    Best thing to do: get healthy, so you don’t need so many costly prescriptions and specialist visits. Not that easy, because we get “trapped in the medicine cabinet.” For 20 years I had chronic disease of fibromyalgia and mystery symptoms, then a year of escalating bizarre symptoms that were pushing me over the edge, off the cliff, and deeper into specialists who only know one body part, don’t read outside their journals, and have tunnel vision and blinders. Their answers? Dive deeper and more often into the pharmaceutical pool. By luck, chance and the grace of god, an integrative doctor I was seeing outside of my health plan heard a presentation at a conference by a guy across the country who had been seeing and helping patients like me for decades, written up only in case report journals.

    The root of my problems, and the keys to many if not most chronic diseases: unfortunate combinations of genes and toxins. Nobody looks for this. When they do, and when the FDA protects people and health, instead of dated and dangerous industries, we can get and stay healthier again at comparatively modest and time limited expense. Provide transparent information about toxins in everything we eat, use, chew with and install as medical devices. Screen people for gene glitches and toxins, call in Dr. House to inspect the house, and watch chronic disease rates fall. Share incentives for recovery with patients and they will be motivated by more than sheer desperation to find out what is really wrong, and how to get better.

    Nothing like toxins in the body and brain to make it start to fall apart and malfunction, mess up your sleep, mess up your body and mind, flame up inflammation. Think about your body and brain like the way you think about your car, engine, ignition and electrical system, etc.

    To control costs best, bring the elephants outside the room into the room: genes, toxins, dentistry, biocompatibility, systemic low-grade infections, and regulations that help or hinder. Align knowledge and information, best practice and regulations to support health, and reform becomes a prescription for health, rather than a rationing exercise among costly, lifelong Rx.

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