Since the 1990s, the number of specialty drugs available on the market has increased exponentially. Employer-sponsored health plans have seen a rise in pharmacy expense due to the increasing availability and costs of these medications.
As a result, employers are seeking innovative approaches to curb specialty spend. For companies with self-funded health plans, these approaches may include establishing specialty carve-outs, introducing specialty coverage limits and implementing international specialty medication insourcing. They may lead to unintended compliance, regulatory or other consequences, however.
The practice of importing medications from other countries to leverage international cost savings, for example, is considered illegal by many regulatory bodies. Excluding coverage of a given medication could produce a significant, unintended therapeutic coverage gap for employees. Limiting coverage could lead to untreated medical conditions which in turn could lead to less productive or absent workers and increased rather than decreased employer costs.
An experienced pharmacy benefit manager can help employers explore unique solutions and understand the risks and consequences of implementing them. Making these decisions without the advice of a clinician could lead to a negative outcome.
As an extension of your team, your local Hylant employee benefits expert is ready to assist you in developing a strategy to contain costs and implementing a compliant program that supports the needs of your employees and their family members.
The above information does not constitute advice. Always contact your insurance broker or trusted adviser for insurance-related questions.