Prescription Drug Plan Design
More plan sponsors are considering the adoption of a value-based plan design. This approach focuses on lowering or eliminating members’ out-of-pocket costs for drug therapy with the goal of improving their medication compliance. Some plans promote this design for all members being treated for certain core conditions (hypertension, asthma, diabetes or high cholesterol), while other plans prefer to only qualify those members who have been risk-stratified based on the likelihood of avoiding a preventable medical event. WBC can help you with this evaluation, including financial modeling that analyzes the impact of a formulary redesign and the elimination of copayments for certain generic and brand name prescriptions, and for risk stratification of specific populations.
Our analysis will also compare and contrast your plan design with regional and national benchmarks, creating a financial dashboard of metrics regarding cost and utilization. It will demonstrate cost savings for plan options and the financial impact of changes in co-payments, plan caps, prior authorizations, step therapy, four and five-tier benefit designs and other suggested cost-containment alternatives.
Regardless of the plan design you choose, WBC can assist you in mazimizing its impact on reaching your pharmacy benefit objectives.