“If health insurance didn’t cover expensive drugs they wouldn’t be expensive” – Molly Mulebriar
We didn’t cover expensive drugs in the past. Why should we now? High cost drugs are bankrupting health plans and it’s going to get worse. Plan sponsors can’t continue paying these high cost drugs without reducing core health care benefits, laying off workers, and reducing salary and wages. There’s no escaping that. There’s no Magic Dust solution.
Here are a few common sense solutions to reducing Rx costs:
- Cover drugs that cost less than $670 for a 30 day fill, exclude all others
- Eliminate all plan paid Rx that can be purchased at Walmart or HEB for $4-$6
- Capitate 1,000 common prescriptions for $7 pepm covering every therapeutic class
- Stop upfront Rx financing – Patient pays and files a claim for reimbursement
- Separate Rx Maximum Out-Of-Pocket from medical benefits
- Cover drugs on the World Health Organization Essential Rx List
- Eliminate co-pay & replace with 50/50% coinsurance
- Cover only generic drugs (Texas County Eliminates Brand Name)
- Eliminate the PBM
