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Biotechnol Healthc. 2010 Spring; 7(1): 31.
PMCID: PMC2873728

Employee Cost Share Rises; Employers Still Paying More

Amy Rossi, Assistant Editor

According to Medco’s 2009 report “9 Leading Trends in Rx Plan Management,” nearly 70 percent of surveyed organizations intend to increase their employees’ cost sharing for medical care this year, compared with 46 percent last year. Medco’s survey also revealed that 80 percent of organizations appear to be more focused on cost-saving strategies, such as integrating drug and medical claims data and implementing clinical management programs, while 73 percent intend to implement clinical management programs. Most respondents — 86 percent — encourage the use of prescription mail order to further manage costs; 32 percent are actually mandating this procedure.

“We have seen an average rise in employee contributions, caused by inflation and rising unit costs, to ensure that employees are maintaining a percentage of the total cost of care,” says Tim Wentworth, group president, employer accounts for Medco. “Employers are paying a large percentage of that total, so when the cost of care rises, absolute employer costs subsequently rise dramatically even as employees maintain a percentage of that total cost of healthcare.”

“We work very hard with employers to make sure employees remain adherent to their prescriptions, and we’re seeing plans set monthly or annual caps and out-of-pocket maximums to allow more drug access for patients.”

Medco’s survey shows that 31 percent of organizations surveyed are planning to limit their coverage of specialty medications.

“More plans are moving to specialty pharmacies for increased management and distribution of specialty medications,” says Wentworth. “And when one specialty drug is not preferable over another, we need to choose the drug which represents the lowest cost for the plan and the patient.”

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Cost-share strategies that organizations definitely or probably will implement over the next 2 years, by company size

Medco recommends that employers use cost share to achieve specific goals, such as waiving cost share on essential medications like those for diabetes and hypertension to encourage adherence, or using coinsurance to make the cost of medications visible and influence purchasing decisions. Source: “9 Leading Trends in Rx Plan Management: Findings From a National Peer Study,” Medco Health Solutions, 2009

Articles from Biotechnology Healthcare are provided here courtesy of MediMedia, USA