How Member-Centricity Drives Effective Pharmacy Strategy

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[This is the first blog in a three-part series exploring how member-centricity is the crux of a productive pharmacy benefits strategy. Read part two here and part three here.]

Pharmacy benefits continue to be an area of focus for employers and their broker partners as pharmacy costs continue to increase year-over-year and represent 10% of overall healthcare spend. With more than 66% of all adults in the U.S. taking a prescription medication, and almost 40% of Americans managing at least one chronic condition, it is almost certain that no matter the size of employee population, access and affordability of prescription drugs is a top-of-mind issue.

The good news is there are many models emerging that help employers best manage overall healthcare expenses. Employers have the option of being fully insured or self-funded, and can decide whether or not to take advantage of a pharmacy carve-out strategy, among other innovative approaches for driving cost-savings. The key to creating a robust benefits program while balancing cost-containment, however, is to build a program rooted in member-centricity.

What is member-centricity?

A member-centric pharmacy benefits strategy places the unique employee population needs at the center of program decisions and is focused on ensuring affordability, access and adherence for all. To achieve this, organizations must recognize the factors that affect these goals, learn how to remove these barriers, and understand what data is available to support sustainable long-term pharmacy decisions. Connecting employees to the care they need is a key responsibility for employers and a member-centric approach is simply the right thing to do.

Why is member-centricity so important?

Providing accessible and affordable prescription medications to members may require rethinking the pharmacy benefits program. With a shifted focus to making data-driven decisions, employers can take control of their pharmacy program and provide both cost savings for the organization and promote employee satisfaction and retention.

Achieve better cost savings for the organization

When benefit decisions are not designed to the unique needs of the population — employees can face burdensome out-of-pocket costs, forcing them to make tough decisions about filling their prescriptions or not. Lack of access then affects quality of life and the employee’s ability to thrive in the workplace. Untreated conditions can evolve and expand into more complex issues and ultimately cause more downstream costs for both the employee and employer.

As employers and brokers implement their pharmacy programs, analyzing utilization data to fully understand the member population’s unique requirements is critical. It helps reveal contract optimization opportunities, non-negotiables in the procurement process and ultimately can lead to meaningful cost-savings, enhanced member access and improved adherence to treatment.

Increase member retention and satisfaction

Members who feel that their employer is invested in offering them quality benefits and educating them on how to use them will be less likely to leave the company. Almost 56% of respondents to a recent AHIP survey indicated that employer coverage is a key factor in their decision to stay at their current company. With a more centralized focus on member needs, and a strong pharmacy benefits plan, employers can positively influence member retention and satisfaction strategies.

Strategies for building a member-centric program

An organization that is not taking a member-centric approach to building a pharmacy benefits program might be losing out on the opportunity to drive better financial and health outcomes for both the organization and the employee. The most powerful way to proactively support this approach for pharmacy is to:

Employ an effective procurement strategy and claims monitoring approach. Organizations must have visibility into their PBM offers, and weigh their options with respect to members needs to ensuring that the benefits plan is sustainable and managed over time.
Leverage claims data and market insights to help fully understand the needs and make better decisions.
Empower employees with the right information and solutions to best manage their options.

Addressing these areas allows the organization and their broker partner to best serve members throughout the pharmacy lifecycle. Stay tuned for the next blog post that outlines the three strategies Truveris has identified to take a member-centric approach to pharmacy benefits.