Benefits management services provider Express Scripts Canada has announced the introduction of a new business model, which, it says, will enable companies to better control the costs of their drug plans.
The new model is based on an expanded pharmacy benefits management (PBM) service and home-delivery pharmacy. It is designed to complement existing drug benefits programs provided to plan sponsors by insurance companies and third-party benefits administrators, and can be added without changing insurance carriers.
The program will rely on active intervention—connecting with employees throughout the year—to raise awareness of what healthcare options are available to plan members. As well, Express Script’s home-delivery pharmacy will enable pharmacists to work with employees and their physicians, and to have an understanding of the employee’s benefits plan.
Michael Biskey, president of Express Scripts, says that traditional benefits programs don’t engage employees or make them aware of what options are available or how costs can be controlled—for both the employee and the employer.
“You read the plan and then you forget about it,” he says. “You show up at the pharmacy with your prescription, you get it filled, and you pay whatever they ask. The employer has a few controls that are built in to the adjudication system that it hopes are effective, but its strategy is really hoping that employees remember what’s part of their prescription drug program and try to manage it themselves.”
Express Script’s new model uses techniques based on behavioural science to raise awareness among employees and help them make better healthcare decisions. For example, the program may look to loss-aversion theory—in which people avoid losses as opposed to seeking gains—and craft a message that addresses that attitude. Such techniques might include stressing how better health management can help an employee avoid wasting money, rather than help him or her save money.
“There’s a lot of concern today about the sustainability of drug benefits, in particular with the new medications that are coming out—specialty drugs, for instance,” says Biskey. “If the employer and employee can’t manage current maintenance medications—with generics and lower-cost alternatives—they will certainly be unable to manage the specialty drugs. This is an opportunity to engage employees, to help them understand how to drive better health as well as savings for themselves and the employer, so the employer can continue to fund the benefits plan in the future.”
Express Scripts Canada will officially launch the new PBM service on Jan. 3, 2012.