Rising costs due to behavior-driven conditions significantly impact health plan costs, report says

The rising cost of specialty drugs, challenges with medication adherence, and the utilization of mail order are among the top trends impacting employers and other health plan sponsors, according to a recent report about prescription benefit management trends.

According to Express Scripts' fifth annual report, "Nine Leading Trends in Rx Plan Management," more than 75% of plan sponsors say behavior-driven conditions are the greatest contributors to plan costs.

While the healthcare profession has made great strides in medication adherence, patients are busier and have more information coming at them than ever before, said Tim Wentworth, president of sales and account management for Express Scripts. "It is very difficult to get and keep people's attention," Wentworth said.

Thirty-six percent of plan sponsors cite the rising utilization and cost of specialty medications as the greatest concern in managing their prescription plans. Another 38% cited "overall drug costs" as their chief concern in managing costs. As a result, 74% intend to require preferred pharmacies in the next 2 years, and 59% say they plan to move specialty medications from the medical to the pharmacy benefit over the next 2 years.

Health plan sponsors still consider mail order to be significantly more cost-effective for their members than retail pharmacies. According to the employers and other plan sponsors, mail order has an advantage over retail in improving adherence, reviewing prescriptions, and dispensing safely. "Mail order continues to be an important part of overall care . . . especially when a patient has been diagnosed with a complex or chronic disease," Wentworth said.