Employers Take Charge of Your Prescription Costs

As employers augment their involvement in the health benefit management of their employees, we should not be shocked or surprised to see push backs from parties in the health care industry who feel threatened by the increasing education and involvement of the employers in the delivery system.

The on-site clinics pioneered by EHCS, which is based on a book I published in 2007, tackles areas of health care waste and strategies that promote access to care. These are the two fundamental issues that are at the core of the health care vast problems.

Waste at the pharmacy benefit level is of great significance financially, but as a physician I am more concerned about its impact on patients’ lives and well-being. Whenever the pharmacy benefit cost is inflated, we expect and do encounter negative impact on patients. As increasing number of payers and employers are shifting the cost of pharmacy benefit to patients, we should not be surprised to see patients’ compliance challenged. I see this every day in our cancer center. The more expensive the drugs, the larger is the patient's out-of-pocket share of drug cost and expense. Patients are human beings like all of us. We have rationalization abilities that justify doing what we know is not the right thing to do.

Patients don't take the drugs as scheduled as a money-saving maneuver and that is detrimental to their health.

The on-site clinics run by EHCS has solved all those intricate problems I alluded to, since most of the prescription drugs are made available to patients at no cost (thanks to our partners). The employers realized that it is more cost effective for them to totally subsidize the cost of prescription drugs, eliminating the co-pay factor, thereby enhancing compliance and minimizing the risk of complications from inadequately managed chronic illnesses.

In addition to providing better services to their employees, the employers are saving money, since what they pay for the prescription drugs is substantially less than what their share is when the prescription is run through the traditional pharmacy benefit.

It must be expected that retail pharmacies and specialty pharmacies are going to fight back in an attempt to maintain that piece of the pie. Unfortunately for them, the saving and benefit from enhanced access for patients are so overwhelming that such attempts will only amount to an exercise in futility. Specialty pharmacies have to adjust and acclimatize to the new world. The whole mark of this decade will be viewed in history as the employers’ era.

They are in the driver’s seat instead of relying on their insurance companies, their consultants, and several layers of middlemen for any service provided. The employers are amazed to discover that indeed better medicine is cheaper medicine.

Through the on-site clinics, access to care and compliance with doctors visits and medication dispensing has resulted in medicine being practiced as we learned it medical schools.

As described in my book, Good Medicine is Cheaper Medicine, lower cost is translating into better access and better outcomes.