PBMI Report Shows Changes in Pharmacy Benefit Design to Meet Cost Challenges

DATE: November 3, 2017

PBMI Releases 2016 Trends in Drug Benefit Design Report

Plano, TX (Marketwired – December 12, 2016) ―Although employers continue to cite managing drug cost trend as the number one goal, they are addressing this challenge head on by implementing significant changes in drug benefit design.  This is just a sampling of the results from PBMI’s 2016 Trends in Drug Benefit Design Report released today.  The report includes responses from 337 benefit leaders representing employers with an estimated 12.3 million covered lives.

“As drug costs continue to rise, it’s no surprise that this year’s report shows employers maintain focusing their goals in the areas of managing specialty and overall drug benefit cost trend,” says Jane Lutz, Executive Director of PBMI.  “As employers look to the future, collaboration to design more effective benefit designs is critical.”

The following are a few of the key findings from this year’s report:

• Employers are changing pharmacy benefit designs to manage cost increases
  • Plans with four or more tiers continue to grow – 38% have four or more tiers, compared to only 26% in 2012
  • Use of pharmacy deductibles are common and growing with 38% having a pharmacy deductible, either specific to the drug benefit or combined with the medial benefit
• Employers are also increasing use of incentives to  encourage healthy behaviors
  • Rewarding members who participate in health risk assessments increased by 12%
  • Use of incentives to motivate behavior change rose 17%
  • Reducing  copayments for members who participate in care management programs increased 1%
• The report also identifies several opportunities
  • 64% do not use preferred or limited retail networks
  • 47% do not send member communications to encourage mail order or on-site pharmacy use
  • Only 62% of employers reporting they currently have a program in place despite epidemic rates of substance abuse

“We hope our research continues to drive meaningful conversations and brings together all stakeholders involved in benefit design creation,” adds Lutz.

PBMI will host a free webinar on December 15 at 1:30 pm EST to showcase the report.  Register today. To download or request a printed copy of this report click here.

About PBMI

The Pharmacy Benefit Management Institute provides research and education to help healthcare and benefits professionals work with pharmacy benefit managers to design prescription drug benefit programs. Learn more at www.pbmi.com.