Did that stat make you pay attention? It should.
Even if you offer insurance to your employees, they still might struggle with taking their medications and treating chronic conditions such as diabetes, high blood pressure, or high cholesterol—or taking any needed medicines for their health.
And you may not even know it.
The effects of medication non-adherence
Medication non-adherence means people cannot take their medication for varying reasons. They either skip doses, take smaller amounts, or stop taking their medications altogether.
The national medication adherence rate hovers at around 50% and this rate can go down more with the more barriers the person has, such as rising costs and lack of availability of generic medicines (though this availability is improving. 91% of all prescriptions filled in the US are generic medications).
Health literacy is also an issue. Some people don’t understand what’s in their health insurance, how to take their medications, or their side effects. So, they’ll stop taking their medicine when they feel better or have side effects—and won’t discuss this with their healthcare provider.
Even with the improving availability of generics, costs can still be a factor. For instance, hepatitis C medication can cost as much as $73,000 a year; cancer drugs for leukemia, metastatic prostate cancer, and some types of lung cancer can cost as much as $88,000 a year.
Insurance may also have coverage limitations such as high copays and deductibles and a number of other limiting factors:
- Tiered formularies: Some plans categorize medicine into different tiers, with newer, more expensive drugs in higher tiers.
- Prior authorizations: Some plans require approval from the insurer before covering certain medications.
- Step therapy: Insurers may require a person to try less expensive medications first before covering a needed option (which might be more expensive).
- Quantity limits: Some plans can limit the amount per prescription or the total amount per month.
- Exclusions and restrictions: Certain types of medication, like fertility drugs, may not be covered or require special handling and have more restrictions.
Whether the barrier is cost, availability, insurance coverage limitations, or not understanding side effects, these barriers can contribute to lost productivity and increased use of expensive ER visits and in-hospital care. As an employer, you want employees to be healthy and productive. Offering benefits and assistance with medication costs and other barriers is a win/win scenario for everyone.
How you can help
If you want to ensure employees have their needed medications, can afford them, and understand certain things like side effects and how to communicate with their healthcare provider, there are ways you can help.
Enhance your medication benefits
With the help of a trusted insurance advisor, examine your current medication benefits and coverage limitations. For instance, how much are the copays? What is the Rx deductible? Can you offer increased contributions to Health Savings Accounts (HSA)? Are any medications currently excluded or restricted? Knowing what you offer now can help you decide where to improve.
Work with a Pharmacy Benefits Manager (PBM)
Pharmacy Benefits Managers (PBMs) intermediate between insurance companies, pharmacies, and drug manufacturers. They secure lower drug costs for insurers and insurance companies. You can partner with a PBM to reduce drug costs, but remember to consistently manage your PBM relationship so you and your employees get the most out of it. Also, explore additional PBM services or member advocacy programs that may already be built into your PBM’s services that are often not talked about.
Encourage the use of Patient Assistance Programs and Manufacturer Assistance programs
A Patient Assistance Program (PAP) and a Manufacturer Assistance Program (MAP) are two types of financial assistance programs that can help your employees with the price of their medications. PAPs provide financial assistance to help people access their medications for little to no cost, and MAPs help with copays, deductibles, and other out-of-pocket medication costs. If insurance doesn’t cover the cost of a drug, these programs are available if your employees meet certain eligibility criteria.
Look into international Rx programs
An international prescription (Rx) program allows people to access prescription medications from pharmacies in other countries, typically at lower costs than in the United States. These programs allow prescriptions to be filled at certified international pharmacies that meet quality standards, and people can get their medications delivered by mail. If you want to offer an international Rx program to your employees, compare what’s out there to find the best one for your group.
Prioritize employee education and communication
You don’t want to leave your employees in the dark regarding their benefits, so education and communication are essential. This way, they know exactly what’s in their benefits, how to use them, and how to communicate with their healthcare providers to manage their conditions and any medication side effects.
Look into programs that offer drug coupons, discounts, or self-pay
Discount pharmacy cards, such as GoodRx, let your employees compare prices at various pharmacies, and, at times, they can save a little more on their medications than using insurance alone. Self-pay programs, like DiRx, are another option employees can use to receive their medicines at a lower cost. If pointing your employees toward these programs, encourage them to check how much their medication costs with insurance and compare this to the prices and discounts they might receive with these programs.
Be flexible with time off for medical needs
Chronic conditions, even when managed with medication, can cause health issues. Be flexible with time off for medical needs and encourage the use of telehealth so employees and their healthcare providers can manage any conditions in the privacy of their homes.
You can help
Whatever barriers your employees might face, whether it’s cost or health literacy, you can help. Be sure to talk with your insurance advisor to learn more about how you can help your employees and to learn more about your available options.
Content provided by Q4intelligence
Photo by everydayplus