Member Affordability

The cost of health care is a major source of worry for plan members, especially for those enrolled in high deductible health plans (HDHPs). Because members in HDHPs are responsible for 100 percent of the cost of their care until they meet their deductible, for some that could mean thousands of dollars of out-of-pocket (OOP) costs each year. In a 2022 survey, annual premiums for employer-sponsored family health coverage reached $22,463 this year, with workers on average paying $6,106 toward the cost of their coverage. The average deductible among covered workers in a plan with a general annual deductible is $1,763 for single coverage.

Helping lower member OOP costs can help improve adherence and satisfaction. In order to help members afford their medications and to support better overall outcomes we have developed a range of plan design strategies, such as point-of-sale (POS) rebates and preventive drug lists with $0 copay. Digital tools such as Real-Time Benefits and Savings Advisor provide greater cost transparency enabling members to make more informed decisions about choosing cost-effective medications.

Along with essential strategies such as formulary designs that promote the use of lower-cost drug options, these initiatives have helped lower OOP costs per 30-day prescription and reduced member cost share. Seventy-two percent of members spent less than $100 OOP in 2021.

Despite rising drug costs, we reduced member cost-share by 27% over a 5-year period from 2016-2021

72.1% of members spent less than $100 out of pocket

Member average out of pocket cost per 30-day supply $9.72 In 2019 $9.63 In 2020 $1.63 Since 2015

72.1% of members spent less than $100 out of pocket Member average out of pocket cost per 30-day supply $9.72 In 2019 $9.63 In 2020 $1.63 Since 2015

Real-Time Benefits

Cost can be a barrier to adherence and higher OOP costs can force individuals to make tough choices about whether to fill a prescription. 

With our Real-Time Benefits solution, members can access prescription cost and the most updated benefit information – including their exact stage in the deductible – wherever they are: at the doctor’s office, the pharmacy, at home, or on the go. 

Point-of-Sale Rebates

POS rebates help offset member OOP costs, especially during the phase when they are responsible for the full cost of the drug, by passing on the discount to members when they pick up their prescription at the pharmacy. Clients can choose to pass on part or all of the discounts we negotiate with manufacturers on their behalf.

Over 18M members enrolled in POS Rebates.

Enhancements made for 2020 included the option to implement POS rebates for specific drug classes or lists, diabetes drugs, specialty treatments, a preventive drug list, or drugs with lower list but higher wholesale acquisition price. 
 

Want to learn more about how to help manage costs for your members? Ask Us