Ways to Manage Drug Plans in 2021

group benefits insurance

Benefit Plan managers will be facing several challenges in 2021.  As the pandemic continues to take its toll, employees will continue to become ill, with COVID-19 or other health issues, or both.  Mental health issues will continue to be a serious reality for many employers and their employees. And to add to these realities, drug prices are predicted to climb in 2021 as well!

So how can Benefit Plan Managers manage the costs of drugs better in 2021?

There are several approaches that can help manage drug costs with smarter spending and that begins with understanding where extra spending can be reduced. Through our experience, we have been able to recognize very visible areas in which extra spending occurs such as:

  • Purchasing brand-name drugs when generics are available
  • Using a new, more expensive medication when the current medication produces the same results
  • Using pharmacies that charge higher dispensing fees
  • Incurring multiple dispensing fees for frequent refills of maintenance drugs instead of opting for a longer day supply
  • Prescriptions that are not taken as directed which can cause a recurrence or worsening of an illness


Generic substitution

Implement mandatory generic substitution by limiting reimbursement of brand-name drugs to the lowest-cost generic equivalent. The member can access the brand-name drug by providing evidence that the generic equivalent is not appropriate.

Step therapy

This limits reimbursement of more expensive second-line medications used to treat chronic conditions to members who have previously tried the co-line options.

Dispensing fee caps

Place limits on dispensing fees, as this encourages members to find pharmacies that charge reasonable fees.

Dispensing frequency caps

This limits the number of dispensing fees reimbursed for maintenance medications and encourages members to choose longer day supply and to discuss a more practical dispensing period with their doctor and their pharmacist.

Preferred Pharmacy Network (PPN)

This is a network of pharmacies where the dispensing fees and pharmacy mark-ups have been negotiated between an insurance carrier and the pharmacy. Sometimes these agreements include other services such as access to disease management programs.

Member Education

Educate members about prescription costs with online tools and apps that can help members estimate the costs of their prescription. When members are better informed, they can make better choices.

These are just a few of the ways Benefit Plan Managers can reduce their drug costs in 2021. At Health Risk Services, we help advise manager on how to craft and implement these kinds of measures that will assist in the containment of costs and exposures to your plan. We will also assist you with the communication and education of your members about these practical steps to reduce costs while maintaining their health and sustainability of the plan.  

We would like you to know more about how Health Risk Services can assist you with a 2021 plan to lower your drug costs, so please schedule a Complimentary Consultation with us.

At Health Risk Services, we will Empathize, Educate & Empower you and your team into 2021!

To schedule your Complimentary Consultation with Health Risk Services

Please call 403-236-9430 or email: [email protected]