More Employers Embrace Cost-Sharing

July 30, 2009 ( - More employers are using cost sharing as a utilization management tool in their prescription drug programs, according to a new survey.

Buck’s “Prescription Drug Benefit Survey”, completed in July 2009, found that more than three-quarters (76%) of 140 respondent firms use employee cost sharing as a utilization management tool, up substantially from 51% a year ago. According to the survey, the most common target cost-sharing range is 11% to 20% of claim costs (used by 39%of respondents).

“This year, plan sponsors are clearly focused on controlling costs in response to budget cuts,” said Michael Jacobs, a principal and national clinical practice leader at Buck Consultants, in a news release.

Nearly all (99%) respondents provide prescription drug coverage as part of their health care program for active employees. The two reasons given as most important for providing this coverage are:

  • the health of employees
  • business competitiveness

“While the cost of prescription drug coverage varies widely, 30 percent, or the largest group of respondents, said pharmacy benefits represent between 11 percent and 15 percent of total health care costs,” said Jacobs. “This is down from last year’s survey, when the largest group indicated their drug benefits made up between 16 percent and 20 percent of total health care costs. This may be the result of many expensive brand medications moving off-patent and being replaced by lower-cost generics.”

According to the survey respondents, the most important clinical management steps they are taking to control pharmacy benefit costs are broader based than prescription drug coverage. They include care management, disease management, and low-cost generic pricing programs offered by retail pharmacy chains, according to Buck.

"Our survey revealed a disconnect with using low-cost generic pricing as a cost management tool," said Jacobs. "While 73 percent of respondents cited are taking advantage of low-cost generic pricing offered by retail pharmacy chains as a high priority, only 26 percent require their mail service provider to match these low-cost retail generic prices."

The survey found that the following top the list of strategic initiatives for long-term cost management:

  • Providing employees with tools and information
  • Providing employee education
  • Adding consumerism to the program

Specialty Drugs

Employers are now increasing their effort in managing specialty medications - complex drugs that are often injected or infused. According to the survey, 59% of respondents have included adherence to clinical guidelines as part of their specialty drug management programs.

The top priorities in managing specialty drug therapies are:

  • Adherence to clinical guidelines
  • Clinical management
  • Coordination with case managers
  • Centralized distribution

Buck's "Prescription Drug Benefit Survey" - the firm's second annual survey on the topic - is available for $100 from Buck's Global Survey Resources, 500 Plaza Drive, Secaucus, NJ, 07096-1533. Telephone: 1-800-887-0509. It also can be ordered online at .

Buck Consultants, an ACS company, is a human resource and benefits consulting firm with more than 1,500 professionals worldwide.