Pharmacy Benefit Managers Cite Employees’ Unhealthy Behavior as Biggest Challenge: Study

Three-quarters of U.S. pharmacy benefit plan sponsors surveyed said persistent unhealthy behavior among employees is their most vexing challenge, according to a study released May 17 by St. Louis-based Express Scripts Inc.

The report, Nine Leading Trends in Rx Plan Management, indicated that more than 75 percent of the 318 responding plan sponsors believe obesity, smoking, nonadherence to prescription regimens and other poor health choices are the leading drivers behind rising health care costs.

And as costs continue to increase, the report said, plan sponsors have undergone a notable philosophical shift in their approach to prescription benefits management.

In the past five years, the percentage of plan sponsors who list the breadth of coverage offered to employees as a top priority for their plans has fallen 14 percent from 57 percent at the end of 2011. Simultaneously, the percentage of sponsors citing a balance of cost and care as a top plan priority has risen to 78 percent from 41 percent in 2006.

“This is a broad acknowledgement of how critical addressing behavior is to reducing health care costs,” said Tim Wentworth, a senior vice president at Express Scripts, in a written statement accompanying the report. “A vast majority of our clients are now focusing on improving the health behaviors of plan members.”

To combat the issue of poor health choices among employees, 81 percent of plan sponsors indicated that they either have or plan to introduce a wellness program for their employees within two years.

Many plan sponsors, the report said, have turned to more aggressive wellness programs that incorporate a variety of participation and performance-based incentives (and penalties, in some cases), integrated pharmacy and medical utilization data.

Ninety-one percent of sponsors offering wellness programs said they include some type of incentive or penalty structure, while 75 percent said they intend to integrate utilization data by 2014.

“This is critical, especially at a time when rising health care costs, waste from medication nonadherence and suboptimal health outcomes are making it harder to provide a robust pharmacy benefit,” Wentworth said.

Matt Dunning writes for Business Insurance, a sister publication of Workforce Management. Comment below or email editors@workforce.com.

Stay informed and connected. Get human resources news and HR features via Workforce Management’s Twitter feed or RSS feeds for mobile devices and news readers.