Trends in Drug Benefit Design Report Released by Pharmaceutical Strategies Group

Highlights plan sponsors' strategies to address changing environment

DALLAS, June 13, 2023 /PRNewswire/ -- Pharmaceutical Strategies Group (PSG), an EPIC company, is pleased to announce the launch of its Trends in Drug Benefit Design Report. The report delivers innovative research on the latest trends in the traditional (non-specialty) drug benefit. Sponsored by Rx Savings Solutions, it outlines the complexities of designing and managing the drug benefit and the cost challenges faced by consumers and plan sponsors alike.

Key highlights of the findings include:

Plan sponsors are grappling with the potential cost of weight loss drugs.
With respondents divided on weight loss as a lifestyle or chronic condition, 43% cover FDA-approved weight loss medications, and 28% may do so in the next 1-2 years.

"Employers are concerned about affordability, as well as the long-term side effects resulting from chronic use," commented Michael Medel, PharmD, Senior Vice President and Practice Lead Plan Sponsors. "While there is recognition of the positive health benefits of weight loss, the data is lacking today to support any significant cost-offset of those benefits."

Most plans use more than one type of trend and utilization management program, such as prior authorization and refill too soon limits, but these programs can present challenges.
Growing percentages of respondents cited cost and cumbersomeness as barriers to utilization management programs. Two-thirds of respondents wanted more transparency and accountability in these programs, and over half expressed interest in new offerings for tracking and controlling utilization.

Major advancements have been made in gene and cell therapies over the past 5 years, and as the pace of change increases, interest in financial protection products is growing.
Nearly all (91%) respondents have heard of gene therapy financial protection products. While just 7% currently use these products, nearly half are considering it.

"With a robust cell and gene therapy pipeline, plan sponsors are seeking ways to mitigate the financial risk these expensive therapies present while also ensuring access for their members. Although few are currently using cell and gene therapy financial protection products, many are considering it. This will be an interesting trend to watch in the coming years," noted Morgan Lee, PhD, MPH, CPH, Senior Director, Research & Strategy, PSG.

Plan sponsors recognize the need to reduce wasteful drug spend. 
A little over half of plans (53%) take steps to identify and reduce wasteful spend in the formulary; that percent rising to 75% when isolating the data to health plans. Blocks, exclusions, and use of programs and reporting from their PBM are among the most common steps they take to address this problem.

The monetary impact of cost-sharing strategies on consumers has spurred a focus on transparency. The promotion of cost-sharing transparency tools to help members manage expenses continues to rise, from 28% in 2018 to 63% in 2023.

"We are honored to once again sponsor this insightful report, which highlights the importance for plan sponsors to evolve the pharmacy benefit," said Michael Rea, PharmD, Founder and CEO of Rx Savings Solutions (RxSS). "This year, there is a noticeable undercurrent of change in the market. Consumers and patients whose share of prescription drug costs continue to grow are searching for relief and turning to sources both within and outside of the traditional drug benefit. It's a goal all of us in the pharmacy benefit ecosystem to help advance the benefit in ways that produce greater access and affordability, all while controlling spend."

Since the inception of this report, the drug benefit has become more intricate to design and manage. With many new drugs coming to market, decisions around program structure, formulary design, cost sharing, and trend management become increasingly challenging and important. This report helps benefit leaders identify trends and future possibilities so they can adjust as appropriate around these factors and more.

Download the Trends in Drug Benefit Design Report: Trends in Rx Benefit Design | Rx Savings Solutions (rxss.com)

About the 2023 Trends in Drug Benefit Design Report
The Trends in Drug Benefit Design Report provides in-depth insights into traditional (non-specialty) drug benefit trends and strategies and focuses on drug benefit design for the 2023 benefit year among employers, union/Taft-Hartley, and health plan respondents. The survey sample informing this report included 180 benefits leaders. Issues specific to specialty drugs are included in a separate report — Trends in Specialty Drug Benefits. This report as well as prior annual reports conducted by PSG can be found at https://www.psgconsults.com/research.

About Pharmaceutical Strategies Group (PSG)
Pharmaceutical Strategies Group, an EPIC company, relentlessly advocates for clients as they navigate complex and ever-changing drug cost management challenges. PSG functions as a strategic partner through industry-leading intelligence and technologies to realize billions of dollars in drug cost savings for clients every year. https://www.psgconsults.com/  

About Rx Savings Solutions – Report Sponsor
Rx Savings Solutions ("RxSS"), part of McKesson Corporation, works on behalf of everyone who takes prescription drugs and the health plans and employers who cover them. Founded by a former retail pharmacist, RxSS helps members reduce out-of-pocket prescription costs and a health plan's pharmacy spend. The solution layers on top of an existing pharmacy benefit and analyzes individual claims to identify and present cost-saving alternatives to each member. Our member engagement platform notifies members proactively anytime they have prescription savings available. Visit https://rxss.com for more information.

Media Contact
Betsy Van Alstyne [email protected]

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SOURCE Pharmaceutical Strategies Group