Plan Sponsor Refuses Advice and Pays Dearly For It

Please, Oh Please, Take This Advice

By Bill Rusteberg

It’s sad how much drugs are costing these days. Most plan sponsors are simply “sucking it up” and paying for these abusively high and egregious prices funded by rate increases passed on, in part, to plan members.

In looking at a recent PBM report on a group we manage, there are drugs used by plan members that cost $16,000 per month, $15,000 per month, $14,000 per month, $10,000 per month on four members. And there are even more expensive drugs in the report. Over half of the drug spend for this month’s report are for high cost drugs on a handful of members.

I would bet all of these drugs could be obtained through pharmacy manufacturer assistance programs. Anyone want to take me up on that?

Of course plan members have no idea what their drug costs are and the effect it’s having on everyone’s rates. They don’t care because “insurance is paying for all of this.” It’s the OTHER PEOPLE’S MONEY syndrome.

We have other groups that have taken our advice and have excluded most specialty drugs from their formulary. In the past five years not one member in any of these groups, either white or blue collar, have been unable to get their expensive specialty drug for free through manufacturer assistance programs.

So why does this group continue to pay for these expensive drugs when they understand the risk can be transferred? And the worse part is………….as new specialty drugs enter the market the plan pays for them too.

It’s a case of social issues outweighing cost. It’s a case of a group that hasn’t run out of money yet. It’s grist for the pharmaceutical industry.

Que lastimas, this is a group that won’t take our advice on some things. That’s Ok, no one agrees with us 100% of the time.  If they did it would be a perfect world that’s never existed.