Strategies to help keep pharmacy care costs in check

Inflation in the U.S. economy has impacted nearly every facet of American life. You see price hikes at the grocery store — and even at the pharmacy. If you’ve had to pick up a prescription lately, you may have noticed a jump in cost when you check out. You’re not imagining things – prices in prescriptions are going up.

In 2023, drugmakers started the year by raising prices of 450 different medications — with more price hikes expected.

This isn’t new in the prescription world. Costs have steadily continued to climb, increasing 7.7% to $576.9B in 2021 and a further rise of 5% was the projection for 2022.

“The cost of increases in drugs is greater than any other service or market; the only thing even close is college education,” said Matthew Vesledahl, chief affordability officer of UnitedHealthcare Employer & Individual. 

Matthew notes prices have risen between 5% and 15% annually during the last two decades, forcing many employers to have to make difficult decisions. In some cases, this includes shifting costs to employees, raising deductibles or even ending coverage entirely for certain drugs.

But there are solutions that may help employers — and their employees — better manage the cost of prescriptions. 

By taking a holistic approach to patient care and integrating medical and pharmacy benefits, members may save money and improve health outcomes.

For example, let’s say two drugs provide the same protection and effectiveness but the price differs drastically — by thousands. Someone with separate medical and pharmacy benefit carriers may end up receiving the far more expensive medication, because their carrier and pharmacy benefit manager (PBM) are not synced up on how to manage treatment options under both benefits.

“If you buy your medical and pharmacy benefits together, you are more likely to end up with a better cost outcome than if you didn’t otherwise,” Matthew said. “If you don’t manage holistically across your benefits, you risk higher costs.”

The rapid growth, variety and complexity of possible treatments can be difficult to track, especially when faced with a challenging diagnosis. But this also highlights the need to improve collaboration and integrate patient and prescription cost information into providers’ workflows.

For example, the UnitedHealthcare Cancer Guidance Program (CGP) uses evidence-based treatment management and analytics to help ensure quality care with reduced costs. This has led to a 10-to-1 return on investment for some employers, as it leads oncologists to the highest-quality, most cost-efficient treatment regimen option and expedites required authorizations.

Other tools, like UnitedHealthcare PreCheck MyScript®, helps prompt prescribers when there is a lower-cost drug alternative at the time of care with a patient. Employers may save an average of $285 per switch and employees an average of $111 per fill, when a lower-cost alternative is selected.¹

Employees themselves may have additional tools to help them compare prices for traditional generic drugs based on their insurance coverage. These collaborations are becoming increasingly common and are necessary to change the trajectory of pharmacy care costs.

UnitedHealthcare was the first in the industry to eliminate all out-of-pocket costs for five vital medications for eligible members:

• Insulin to treat diabetes
• Epinephrine to treat allergic reactions
• Glucagon to treat hypoglycemia
• Naloxone to treat opioid overdoses
• Albuterol to treat acute asthma attacks

“These are life-saving drugs,” says Kelley Nolan-Maccione, chief product officer of UnitedHealthcare Employer & Individual. “Without these medications, the outcome of an event can be fatal. You don’t want to be in a situation where you are rationing them or taking a chance, because it truly can come down to life or death.” 

Some of the emergency-use drugs covered by the new $0 out-of-pocket policy — which applies to about 8.3M members — might otherwise cost hundreds of dollars, Kelley notes.²