On nearly the eve of its expiration, Congress has extended the ability of high deductible health plans (“HDHPs”) to offer first-dollar telehealth coverage through plan years beginning before January 1, 2025. This will allow participants receiving this coverage to continue to contribute to a health savings account (“HSA") for this purpose.

Separately, the agencies responsible for enforcing prescription drug reporting have issued good faith relief, an extension, and some additional flexibility in reporting.

When considering prescription drug cost savings, plan sponsors know where to look: the cost of specialty drugs.

Specialty drug treatments accounted for approximately 52% of pharmacy spending in 2020, and when 2021 is fully accounted for, that number is expected to increase. Plan sponsors can expect specialty drug spending to hit 55% or more of total drug costs in 2022.

And it’s no surprise that specialty drugs are eating up a huge amount of total drug spending — whether it’s an oncology drug, a drug to treat a rare condition, or a biologic with multiple indications, the annual cost of a single specialty treatment can easily run into five, six or even seven figures.

Because of its increased percentage of total drug spending, specialty drug costs are proving a major headache for plan sponsors. They need to find ways to control spending on these treatments, lest the cost of the drug benefit become prohibitive.

Here are three ways to manage the cost of pharmaceutical benefits.

With over half of today's workforce enrolled in high-deductible health plans (51%), a majority of insured individuals are now on the hook for deductibles of at least $1,400. In addition, those with family coverage are responsible for at least $2,800.

While these higher deductibles are offset by cheaper monthly medical premiums and often by employer contributions to Health Savings Accounts (HSA), HDHP plans are nevertheless structured in such a way as to promote heightened "healthcare consumerism."

Judging by the sticker shock most consumers experience the first time they pay for medical services or prescription drugs without a copay, this heightened awareness of the "true cost of care" seems to be making an impact. As a result, consumers are indeed becoming more proactive about shopping for services and comparing prices, just as they would for any other consumer good.

Many employers, especially those that are self-funded, encourage this type of behavior since it can help them control costs and ultimately save significant dollars for both the company and its employees. (Employers with fully funded medical plans also have plenty of reasons to control their medical claims, though the potential savings often aren't recognized as immediately.)

And while consumers seem to have a love/hate relationship with HDHPs, many of those who take the time to fully calculate the total out-of-pocket cost of medical coverage and care realize that HDHPs, even with higher deductibles, can often save them money.

This isn't to say that HDHPs are for everyone, and if a company isn't helping its workforce adequately prepare for this change in consumer behavior, they are setting themselves up for failure.

Since we wouldn't want that to happen, here are eight suggestions to offer your workforce to help them save money on prescription drugs. In a future post, we'll offer tips on how to save money on common medical procedures.

Please share this information with your workforce. In doing so, you'll be helping them to become better consumers of healthcare and more satisfied enrollees in high deductible health plans.

As prescription drug costs continue to increase, it’s important for employers to understand the trends behind the rise and what they can do to better manage their health care expenses.

This blog post sets out to provide context for why prescription prices continue to rise and offers cost-cutting solutions for employers and employees.

Prescription Drug Cost Drivers

In 2019, the United States spent nearly $370 billion on prescription drugs, keeping trend with significant increases year over year. Although prescription drug spending has historically been a small proportion of national health care costs compared to hospital and physician services, it has grown rapidly in recent years—comprising about 10% of national health care spending.

A multitude of reasons led to this steady rise in prescription drug costs, including the following.

Influx of Specialty Drugs

Specialty medications account for a smaller portion of U.S. prescriptions than non-specialty drugs, yet they commanded nearly half of the pharmaceutical market in 2016 ($180 billion). And that dominance is likely to remain. Specialty drug spending is projected to experience rapid growth over the next several years, due to pricing increases.

Note: Since publishing this post (as seen below), the FFCRA legislation has been revised. While it's been billed as a "technical correction" by Democratic leaders, the changes are substantial. The new measure will still provide two weeks of paid sick leave to workers affected by the pandemic, but the next 10 weeks paid leave will be limited to only those workers caring for a child whose school or day care has been shut down. (Workers who had been in quarantine, or caring for a family member affected by the crisis, will not be eligible for the additional 10 week of paid leave.)

In a press conference just a few hours ago, Senate Majority Leader Mitch McConnell (R-Ky.) announced that the Senate will, in fact, pass the Families First Coronavirus Response Act (FFCRA) which was passed by the U.S. House of Representatives over the weekend.

Senators had been critical of the House legislation, describing it as a “non-comprehensive bill” that simply doesn’t do enough to help small business. Earlier today Senator McConnell went so far to say that the the Senate would not pass the bill unless it included “significant and bold new steps”.

Realizing that changes to the bill would result in the measure having to go back to the House for approval, the Senate reversed course this afternoon, anxious to show the country bipartisanship in the face of a global pandemic.

"A number of my members think there were considerable shortcomings in the House bill. My counsel to them is to gag and vote for it anyway," McConnell said.

McConnell then pledged not to adjourn the Senate until passing the House bill, as well as a third stimulus package, which is expected to top $850 billion and focus on small business and industry.

Here are the details of the "phase two" package the Senate looks to pass as early as this evening.

Yesterday, in an effort to prevent the spread of coronavirus (Covid-19) on its campus, Eli Lilly became yet another high-profile U.S. company outside the state of Washington to ask some of its employees to work from home.

This comes on the heels of similar actions last week by several Seattle-based companies; Amazon, Facebook, Microsoft, Twitter, and Google have all told their employees to remain home.

With a prediction by Harvard epidemiologist Dr. Mark Lipsich that 40-70 percent of the global population will eventually become infected with Covid-19, U.S. companies are all taking note. And with Health and Human Services (HHS) Secretary Alex Azar acknowledging that this is now a public health emergency, government and non-governmental agencies are finally in lockstep.

Accordingly, the Department of Homeland Security (DHS) has issued Covid-19 preparedness guidelines which call for, among other things, stockpiling a 2-week supply of water and food, and obtaining "a continuous supply in your home of prescription medications".

Having Extra Medications on Hand Is An Excellent Idea

The advice of having an emergency supply of medications on hand "is excellent," according to Peter Jacobson, with the University of Michigan's School of Public Health. In an interview yesterday with National Public Radio, Mr. Jacobson went on to say, "People should not be caught short of having enough heart medication, diabetic medication, and anything potentially lifesaving, that they need on a routine daily, weekly, or monthly basis."

That said, and as you and your employees are probably finding out, stocking-up on prescription medications is not as easy as it sounds. Here's why.

Last week, President Donald Trump delivered the 2019 State of the Union Address (SOTU). The SOTU is an annual message delivered by the president to a joint session of Congress at the beginning of each year.

At this year’s SOTU, President Trump discussed issues that have the potential to impact the employee benefits industry, as well as employers offering healthcare and benefits to their employees. The issues he discussed included pre-existing conditions, lower prescription drug prices, and nationwide paid family leave.

While the SOTU is just a speech, often times packed with lofty aspirations, it does sometimes lead to policy. Here is a recap of what was addressed:

Pre-existing Condition Protection

In a departure from 2018 Department of Justice actions, President Trump announced in the address that people who have pre-existing conditions should receive protections. If the administration holds true to this goal, they will likely find cross-aisle support, as pre-existing condition patient protection was a key campaign issue in the midterm elections.

So it was with great interest that we took note of last Friday’s White House Rose Garden announcement by President Trump to “bring soaring drug prices back down to earth” by promoting competition among pharmaceutical companies, and giving private entities more tools to negotiate better deals on the behalf of consumers, insurers and employers.

Somewhat surprising in his announcement was his abandonment of some of the more populist proposals which he boasted about during his presidential campaign, including his promise to authorize the Feds to negotiate directly with drug companies in an effort to lower Medicare drug prices and disallowing American consumers from importing low-cost prescription drugs from overseas.

Nevertheless, both Republican and Democrats (as well as all of us here at the JP Griffin Group) welcomed the President’s attention on combating high drug prices. The looming question remains just how the President’s promises to lower drug prices will play out and if the concepts proposed will ever come to pass.

We certainly hope the plan gains traction as both employers and employees alike could sure use a break from escalating drug prices which have now become a primary driver of health-related expenditures.