Engaging Your Members in New Models

By Tim Thomas / On Oct.25.2016 / In / Width

A Monthly Blog Series - #4 of 5


In this blog series, I’ve discussed ways to review and improve your PBM contract, as well as achieving the best financial value from your benefit design, formulary, and specialty Rx. The next step is to help your members make informed decisions on what medications they should use, where they purchase them, and what cost effective alternatives exist. Making the right choices, with guidance, can help lower out of pocket costs and improve employee adherence to medication treatments, optimizing their health.


Why Adherence? Adherence to medication regimens can be difficult for some members to achieve.   Part of the reason is drugs are getting more expensive and members are paying a higher share of the cost. While members have access to many affordable medications, the cost of some generics, new brands and specialty drugs has exploded. Members are feeling these cost increases when they are exposed to increased use of deductibles and coinsurance versus flat copayments. As out-of-pocket costs increase, members are more likely to stop taking medications as directed by their doctors. When members miss doses, their medications are likely less effective (or not effective at all). In the short-term, you're paying for medications that are not working. In the long-term, under treatment can lead to worsening of your member's medical conditions, resulting in higher treatment costs from hospitalizations or complications. It is imperative that you consider how to increase member adherence and its effect on your total healthcare spend.


Utilize Technology. We recommend that you leverage technology to educate your members about lower cost alternatives. In the age of higher cost drugs, handheld devices, and a culture that embraces technology, there has never been a better time to engage your members with up-to-date medication information. When using smartphones, your members can get information on lower cost alternative drugs, before their next refill, or in some cases, before they fill their first script.   Prices can also vary by pharmacy. These technology tools can also share information with the member on lower cost pharmacies through apps that your organization can choose to create.


A good technology tool (or app) makes it easy for members to contact their doctor or pharmacist quickly to discuss whether a lower cost alternative is a good choice for them. The tool should capture and display the prescriber and pharmacy information so the member can easily act on the message.  


In addition to apps, engaging members through technology could also include by text message, email or access to a web portal. We also recommend that you set up your formulary and benefit design to align with your engagements,  so members are consistently encouraged to use lower cost alternative drugs. This means that your members should always have visibility to lower cost alternatives.   


In next month’s blog, I’ll discuss carving out Specialty Rx, mail order and rebates. In the meantime, please feel free to reach out directly if you have any questions or need Rx benefits advice.


Tim Thomas is a Florida Health Care Coalition Affiliate Partner, a pharmacist, and the owner and executive director of Crystal Clear Rx, a group specializing in pharmacy benefits consulting. For more info, visit www.crystalclearrx.com or call 303-955-7827.