How rising drug costs are impacting employers and employees
Both employers and employees regularly feel the impact of rising health care and medication costs. On the pharmaceutical side alone, industry changes are happening at a dizzying pace— with multi-million-dollar gene therapies hitting the market, continued drug price increases, and a growing number of costly specialty medications seeking FDA approval each year.
3 proven strategies to reduce employer drug spend
The good news is there are several practical strategies brokers and employers can implement now, even before a new plan year starts— to help lower an organization's drug spending. Here is a quick overview of three ways to save money: For a broader look at drug savings solutions employers overlook, it's worth exploring additional opportunities beyond these three strategies.
Review coding of specialty infusion medications
If plan members are receiving infusions of specialty medications, the medication may be billed with a J-Code and will land on the medical side of claims. Hospitals and infusion centers often charge up to three times more for specialty medications through the medical benefit compared to the pharmacy plan.
True Rx Health Strategists offers a solution called True Codes. With this service, highly experienced Nurse Navigators trained in specialty medications work with physicians and patients to source the medication through the pharmacy benefit and explore treatment center options. Often, patients find the location, hours, and check-in process at alternative infusion facilities are more convenient.
Match patients with the most effective medication
If your drug plan doesn’t include pharmacogenomics (PGx), you may be spending more than needed in several large drug categories, including antidepressants, statins, ADHD/ADD medications, and more.
Pharmacogenomics uses a simple cheek swab to determine how an individual patient will process certain medications based on their individual genetics. Health care providers and patients use this information to select the most effective medication the first time, eliminating unwanted side effects and a lengthy period of medication trial and error. Antidepressants are one of the clearest examples of this benefit—learn how gene-based antidepressant matching to cut trial costs can make a measurable difference for plan members and employers alike.
Ask your pharmacy benefits management company (PBM) about pharmacogenomics solutions and best practices for implementing this type of program. Explore how the pharmacogenomics process works through the True Genomics clinical program offered by True Rx Health Strategists.
Explore options for biosimilars
A growing number of biosimilars are becoming available as an alternative to expensive biologic drugs used to treat arthritis, psoriasis, cancer, and diabetes. In some cases, adding biosimilars to your formulary can create significant savings. For employers looking to go further, exploring pharmacy benefits that reduce diabetes spend can yield additional savings beyond biosimilar adoption alone.
If you want to explore biosimilars, it's best to consult with a clinical pharmacist to evaluate the implications for patient care. Biosimilars, though highly similar to their reference biologic drugs, are not identical. A clinical pharmacist can help you assess the potential benefits and drawbacks of specific biosimilar options. Choosing the right PBM partner is equally important—review the 10 items to check when selecting a PBM to ensure your plan has the clinical expertise and flexibility to support these decisions.
Take the next step to lower your organization's drug spend
If you are with an employer, broker, or TPA who would like to discuss strategies to lower drug spending, contact us at hello@truerx.com to schedule a meeting with a True Rx pharmacist and health strategist. If you are an existing True Rx partner or client who would like to explore including one of these options in your existing pharmacy benefit plan, please contact your account manager.
