High-Deductible Health Plans

More employers are offering consumer-directed health plans (CDHPs), which are high-deductible plans offered in combination with an account that enrollees can access to offset the deductible expense. These plans require employees and consumers to pay more out-of-pocket costs before the coverage kicks in.

For employees who are low income or who have high health care needs, these types of plans can potentially reduce their compliance with necessary treatments or avoid care altogether, consequently harming their health and productivity.

However, research has found that some employers are establishing “better practices” in overall CDHP design and in their approach to prescription benefits. For example, some are targeting to mitigate the harmful impacts of blunt CDHP and prescription benefit plan design on high health care need/low-income employees.

This finding from a multi-phase research project, conducted by Benfield-Gallagher on behalf of the National Pharmaceutical Council, investigated pharmacy benefit designs attached to CDHPs. The research was intended to identify the current landscape and best practice approaches for CDHPs and pharmacy benefits, as well as understand the health and economic impact of best practice models and evidence about higher value approaches to CDHP pharmacy benefit design.