New Drug Benefit Design Report Shows Increasing Emphasis on Member Experience

In 2022, the majority of plan sponsors used a drug benefit consultant while designing their drug benefit programs, according to Pharmaceutical Strategies Group’s 2022 “Trends in Drug Benefit Design Report,” sponsored by Rx Savings Solutions. The report, which is based on surveys of 153 individuals representing employers, union/Taft-Hartley plans and health plans that covered an estimated 35.1 million lives, also revealed an increasing focus on member satisfaction.

As high-deductible health plans (HDHPs) became more and more popular in recent years, most employers and health plans offered an HDHP with a health savings account (HSA). Yet only 35% of respondents agreed or strongly agreed that HDHPs manage overall drug trend and 51% thought that such plans help members make better medication choices.

In terms of cost-sharing design, the most common structure across all respondent groups was three tiers, while health plans were more likely to have five or six more tiers. For retail 30 fills — which allow members to procure medications in no more than 30 day-supply increments per dispensing — about 61% of respondents used a copay, and the average copay is $10 for tier 1 drugs. When asked whether they are considering a change to their cost-sharing arrangements in the next two to three years, nearly half said they were not sure yet, with PBM or health plan recommendations as the major decision influences.

About 88% of respondents reported that managing overall trend and drug costs was either their top priority or among their top three priorities, and reducing inappropriate utilization was one of their top-ranked goals outside of managing overall trend.

In 2022, 68% of respondents used a preferred network, up from 53% in 2018. In terms of the formularies, 77% of respondents chose their PBM’s national formulary with or without exclusions. Across respondent groups, member dissatisfaction was viewed as the top challenge associated with formulary exclusions.

The survey also reflected on the changes to health behavior caused by the COVID-19 pandemic. The most common answers were increasing use of telehealth, delaying medical care and seeking out behavioral health care.

SOURCE: “Trends in Drug Benefit Design Report,” Pharmaceutical Strategies Group. Dallas, TX: PSG.

This infographic was reprinted from AIS Health’s biweekly publication RADAR on Drug Benefits.

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