[This is the third blog in a three-part series exploring how member-centricity is the crux of a productive pharmacy benefits strategy. Read part one here or part two here.]
Now more than ever, patients are interested in more deeply understanding their healthcare benefits so that they can make the best decisions for their health while mitigating out-of-pocket expenses.
Plan sponsors play an important role in helping their members navigate their healthcare benefits. Beyond securing great benefits, it is critical that plan sponsors use member engagement strategies to support their employees in understanding their pharmacy benefits – and thus getting the most out of their plan by making medication more accessible and affordable for their members.
Truveris has identified four reasons that underscore why plan sponsors should be thinking about member engagement as a critical component of an effective pharmacy benefits strategy.
1. With the rise of consumerism in healthcare, members are seeking to better understand their benefits
66% of U.S. workers report wanting more education from employers about their benefits. In particular, pharmacy benefits are challenging to understand and navigate. Terminology such as “deductibles,” “step therapy,” and “prior authorizations” can lead members to be confused about their pharmacy journey and the benefits they have. If members are unable to navigate the pharmacy experience, the risk of overpaying for a medication or having a delay in care can be extremely high.
To better understand their options, members are proactively seeking information on their own. The phrase “how do benefits work” has around 3,000 monthly searches, revealing that many members struggle to understand their benefits and are seeking support. This highlights an opportunity for plan sponsors to proactively connect their members with the information and tools they need to access their medications. Those who understand how their benefits work are more likely to utilize them in accordance to the plan, leading to a healthier, more proactive employee population – and to cost savings for the organization.
2. Rising drug costs are pushing members to seek prescription savings
Healthcare costs rose dramatically over the past few years, and drug spend accounts for nearly 10% of total healthcare spend. Simultaneously, as drug prices rise, members are experiencing higher out-of-pocket costs as they become responsible for a larger portion of the cost of their prescription. In turn, 50% of patients don’t pick up their medication at the pharmacy due to cost, and nearly 73% of consumers would change pharmacies to save money on their prescription.
To help pay for their medications, members are looking for tools that can help save money. Discount and rebate programs offered by drug manufacturers provide ways for members to access their medications at lower prices, making prescriptions more accessible and affordable. In addition, tools that show members lower-cost generics, drug alternatives, and local pharmacies with the lowest price for a drug can help both members and plan sponsors save money.
3. Effective member engagement provides data that reveal plan optimizations
Currently, plan sponsors have minimal visibility into the behaviors of their members’ benefit usage. Without insight into trended claims data, plan sponsors have no way to optimize their pharmacy benefits plan. Plan sponsors can steer their members towards price comparison tools, but many of these solutions do not integrate with the pharmacy plan, nor do they guide members through other steps in their journey, like a prior authorization.
With more advanced technology, employers gain powerful insights into trends like switching opportunities for generics, discount card usage, and member adherence. Ultimately, that means plan sponsors can better understand how to continually iterate on the pharmacy benefit program to meet their employees’ unique needs. With a member engagement solution that provides insight into member behavior, plan sponsors can make more informed decisions on future pharmacy benefits contracts and program decisions.
4. Strong benefits can be a differentiator for an organization, especially when paired with member engagement solutions
Amid the “Great Resignation,” it is critical for plan sponsors to consider the needs of their employees to attract and retain talent. Notably, almost 56% of members report that employer healthcare coverage is a key factor in their decision to stay at their current company. Plus, nearly half of Americans are interested in tools that help them compare prescription drug prices. To stay competitive in the market and retain valuable employees, plan sponsors need to not only offer attractive healthcare benefits to their employees, but they must also help members feel empowered to make decisions on their unique plan.
Connecting members with coverage customized to their needs, and then providing the solutions members need to understand how to best take advantage of their plan will set plan sponsors up for success, increasing employee satisfaction and retention.
Ultimately, members want to be more involved in making well-informed decisions in their pharmacy journey. To answer this call, plan sponsors should consider implementing a member engagement strategy into their pharmacy benefits program. By connecting members to tools that educate on benefits and showcase lowest-cost options for medications, plan sponsors can better influence positive member behavior, save money, and foster a healthy and productive workforce.