Rising Costs of Rx: 3 Ways to Maximize Savings
Opportunities with your Employees
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Addressing these rising costs and finding ways to save as much as possible with your prescription drug program is key to managing your organization’s financial well-being.
3 Tips to Help Maximize Savings through your Pharmacy Benefits Manager (PBM)
1) If you have a variable copay solution program, promote it!
Variable copay solution programs are ways that PBMs offer to help control costs on expensive specialty medications, one of the biggest reasons why drug costs continue to rise. At a high level, variable copay programs work by recommending that employees and dependents use a particular card or coupon from the PBM or drug-maker. The covered person, in return, receives the specialty medication at a significantly less cost.
At edHEALTH, we highly recommend that our member-owner schools with a variable copay solution program promote and educate the employees around how it works.
2) Stay connected with your PBM
Your PBM has a wealth of knowledge and resources at its fingertips, both at the industry level and for your organization’s employee population. Regular meetings with your PBM account executive make it easier to stay on top of your pharmacy utilization and claims and learn what’s on the horizon for the next plan year. It’s often a good idea to book a few meetings per year at the beginning of the year to include the annual review of data in the spring. Regular communications can be an effective way to ensure that program-specific communications, like a variable copay solution if you offer it, happen throughout the year. And that you’re doing everything you can to effectively promote the savings opportunities to your employees.
3) Use all available communications from your PBM
Most PBMs create helpful flyers on web content for their customers to share them in organization-wide newsletters, post on your intranet site, or include them during information sessions about benefits. For example, edHEALTH schools have ready-made content available on a variety of topics, including:
- Specialty pharmacy
- Home delivery
- Generic medications
- Digital Rx tools
- Diabetes meter program
Talk to your pharmacy benefits manager about what’s available to you. Educating consumers is an important first step toward employees making smart healthcare decisions.
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Industry-trending Articles of Interest
Challenges of pre-retirees not ready or prepared. Telehealth utilization declined, except for in the Northeast. Realizing and addressing the high costs of healthcare.
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Have ideas on what you want to read in 2023? Share your health-care-related topics of interest with Lisa Barnstein.
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What Human Resources Professionals Frequently Ask Us: |
School leaders often ask questions about edHEALTH and how we work with our member-owner schools. We’re using this edHEALTH space to answer some of the most common questions we receive.
We work closely with our schools’ Finance and Human Resources departments. Together, they play an essential role in the success of our consortium for educational institutions. In our last newsletter, we answered seven common finance-related questions. (If you missed it, read it online here.)
To kick off the new year, we answer a few frequently asked questions by Human Resource staff.
Who is eligible to participate in edHEALTH?
Colleges, universities, and secondary schools are eligible to participate in edHEALTH. Our service area covers the United States from coast to coast.
How does edHEALTH save my educational institution, faculty, and staff money?
edHEALTH’s coalition of member educational institutions provides purchasing clout that helps drive down healthcare costs. By coming together, edHEALTH member-owners realize lower costs than fully insured plans or go-it-alone self-insured options:
- Larger group = better pricing and less volatility
- Low-negotiated Third-Party Administrator (TPA) fees
- Transparent advisor payments
- No payments of profits to TPAs on top of claims (unlike fully insured plans)
- Reduced Affordable Care Act (ACA) taxes
Why should we switch to edHEALTH? No one is complaining about our employee health insurance program.
Healthcare costs put a significant strain on college, university, private, and charter school budgets, which drives up tuition costs. Our member-owned collaborative approach gives your school, its faculty, and staff access to affordable, quality healthcare. Through edHEALTH, your educational institution will play a proactive role in your institution’s healthcare, gain control over plan design, and receive valuable data insights into your trends and cost drivers.
What benefits do we get by joining edHEALTH?
Our member-centric approach to rising healthcare costs provides valuable savings benefits, ownership, transparency, and innovation.
- Savings – Through our purchasing clout, we consistently negotiate lower administrative fees and enjoy less healthcare cost volatility than schools can realize on their own. Our pharmacy carve-out has saved member institutions approximately $65M between 2017 and 2022. Person-centric clinical health initiatives help us improve the quality of care and reduce costs for the employees and family members who need it most. Our results show that our innovative approach is working. The nine-year average health insurance premium increase is 3.6%, well below the industry average of 7.8%. Employee satisfaction, high quality of care, and valuable savings you can pass along to students and families are all benefits of being a member-owner of edHEALTH.
- Ownership – edHEALTH is a member-owned consortium run by and for its educational institutions. As a member, you share in the savings generated by the group. To date, edHEALTH has awarded dividends of over $3.2 million. Member-owners control and have a meaningful say in the decision-making process, along with direct access to plan administrators. edHEALTH provides multiple forums for member-owners to share and learn from one another. Collaboration is a key benefit of belonging to edHEALTH.
- Transparency – Health insurance works when employers have the data they need to make informed decisions. edHEALTH’s transparent approach means member educational institutions are apprised of all rate components. And our collaborative approach enables colleges and universities to compare cost, utilization, trends, and best practices with other member schools.
- Innovation – edHEALTH is the innovative healthcare solution for higher education institutions and secondary schools, along with their faculty, staff, and family members. Our self-insured healthcare offerings are tailored to meet the needs of our members. Through data analysis, advanced, person-centric programs, and decision support, we help educational institutions select programs that meet their needs while containing rising healthcare costs.
Will the switch to edHEALTH disrupt coverage, provider networks, and plan design?
Schools find minimal disruption to coverage, healthcare provider access, and plan design. Our hands-on approach allows new members to experience a seamless transition with little or no coverage or provider disruption. edHEALTH has an active Plan Design Committee made up of representatives from each member institution and their advisors who work with the Third-Party Administrators (TPAs) to determine plan designs customized to meet the needs of edHEALTH members.
How is plan design determined?
Representatives from each member institution (typically the benefits administrators) meet monthly to determine plan design options for the upcoming plan year. The Plan Design Committee’s collaboration with the Third-Party Administrators (TPAs) helps to ensure the optimal suite of choices. edHEALTH works with new member institutions and their advisor to tailor plan designs as needed.
Can edHEALTH’s plan designs support religious institution plan accommodations and exemptions?
Yes. edHEALTH customizes its medical and pharmacy programs to meet the needs of religious institutions.
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Happy New Year Message from edHEALTH's President and CEO Tracy Hassett
Have you had the opportunity to read our January President's Message? If not, you can read it now here.
In it, Tracy Hassett highlights edHEALTH's 2022 accomplishments and previews what's ahead in the coming year. Have questions or want to learn more? Please reach out. Thank you.
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edHEALTH represented at Vermont's 2023 Legislative Day
On January 18, edHEALTH President and CEO Tracy Hassett had the honor of attending Captive Legislative Day at the Vermont Statehouse. Tracy shared how edHEALTH continues to help our member-owner educational institutions with their healthcare challenges.
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Updates related to what's coming soon and what's available in the edHEALTH Portal
Plan Design Committee (PDC) Meeting Update
Now that 2023 is well underway, edHEALTH and our member-owner schools are busy working on a few priority initiatives. As the next couple of months will focus on these specific topics, look for our PDC meetings to return in March. Your email PDC invitation will arrive sometime next month.
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New Custom Templates for Member-Owners in your edHEALTH Portal
Based on early strategic planning conversations, we developed two documents to support our member-owner schools and their employees.
All-in-one behavioral health flyer: Schools looking for an easy way to share the many behavioral resources available to faculty and staff, like from your Employee Assistance Program (EAP) or your third-party administrator (TPA) or health plan, now have a customizable ready-made flyer available. Three versions are available in your portal. Choose the one that references your TPA. Then, personalize it with your EAP information and school logo. If you'd like assistance, contact Lisa Barnstein.
Template for retirement benefits transition: As one of our member schools already uses a detailed letter outlining resources for Social Security, medical insurance (Medicare and COBRA options), and retirement benefits, we were able to turn their letter into a template for all member schools to use by populating with your specific information.
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Simply forward the email you received to pass along this month's edition.
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