Mercer Unveils Pharmacy Benefit Plan Design

January 23, 2008 (PLANSPONSOR.com) - A new Mercer's pharmacy benefit design can help hold down overall costs by encouraging people with high cost chronic illnesses to comply with treatment plans.

A Mercer news release said its Dx-Rx Pairing is based on clinical evidence indicating a link between a specific diagnosis (Dx) and a specific regimen of prescribed drugs (Rx) results in better patient health and a cut in other medical costs. Traditional plan designs frequently end up charging high co-payments that effectively discourage the use of diagnosis-prescription drug pairing, Mercer claimed.

The new pharmacy plan can cut an employer’s total health care spending by an estimated 1% to 2%. Mercer said its plan is different than others in the market because it targets only those combinations of diagnoses and drug therapies that have been medically proven to improve health status while lowering overall health care expenses.

The new plan design was intended to combat three current flaws in pharmacy benefit plan setups:

  • It minimizes financial barriers to compliance by reducing or eliminating member cost sharing for designated diagnosis/drug pairs.
  • It encourages first-time prescribing by doctors through proactive communication.
  • It calls for contact with members not properly following the treatment plan.

“Today’s pharmacy benefit plans typically are designed to reduce drug cost only. They provide little to no monitoring of compliance and miss significant opportunities to improve health,” said David Dross, national leader of Mercer’s managed pharmacy consulting group, in the announcement.

The program was developed in conjunction with a number of national experts. For more information, visit  www.mercer.com .

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