Striving for the Best Pharmacy Benefit Design: The Most Influential Factors


pharmacyThe best pharmacy benefit design is one that addresses many factors and implements effective control pharmacy benefit cost. After all, there’s really no one design that will fit all benefit plans.

Critical Cost Factors says cost is probably the most crucial factor when designing a cost-effective pharmacy benefit plan. While there are plenty of influencing factors that can make or break the cost-effectiveness of a benefit plan, the biggest one has to do with the product list that will be covered in the plan. A plan that only covers generic drugs is undoubtedly the most cost-effective, while one that covers only prescription drugs will be very expensive.

With this, the right benefit plan must offer coverage for certain prescription and generic drugs. In addition, another significant factor that affects cost is the copayment amount that members are required to pay for every single prescription received. This also includes maximums, as well as up-front deductibles.

The Right Level of Pharmacy Benefit

The right level of benefit that employers can offer are typically influenced by external factors, including benefits provided by similar businesses in the same industry and collective bargaining agreements. Otherwise, it can be entirely controlled by the employer as influenced by particular economic drivers.

Because of the many aspects of pharmacy benefit planning, it is important to consult with knowledgeable and experienced pharmacy benefit consultants to determine, implement, and manage the most ideal plan for your specific requirements. Note that not all consultants are familiar with various design options and their interactions. In addition, some may not have the proper clinical expertise or background to offer sound recommendations on what therapeutic categories to exclude and include in your plan to maximize benefits for everyone involved.

A properly planned and implemented pharmacy benefit plan will make sure your members will be able to receive medications required to maintain and accomplish optimum health, while also offering cost effective therapy minus the high costs. The right plan will also help in reducing inappropriate benefit usage, prompt members to use more affordable medications, and empower them to consider more reasonably priced treatment alternatives with their doctors.