A unique survey of large employers sheds light on the strategies and best practices that they follow when designing and implementing consumer-directed health plans (CDHPs). The survey, conducted by The Benfield Group on behalf of the National Pharmaceutical Council (NPC) and highlighted during a July 23, 2014 webinar, found that employers tend to follow a standard model and that pharmacy benefits “play second fiddle” to medical benefits in these plans.
CDHPs are high-deductible plans offered in combination with an account that enrollees can access to offset the deductible expense. Premiums are generally lower than in traditional plans because enrollees must meet the higher deductibles before traditional medical and pharmacy coverage begins. CDHPs have the potential to help contain health care costs and engage enrollees more fully in managing their health and health care decisions, and these plans are growing in popularity among employers. There are two main types of CDHPs: health savings accounts (HSAs) and health reimbursement accounts (HRAs).
Chuck Reynolds, president, employer practice, The Benfield Group, who participated in the webinar, noted that it remains unclear which primary preventive medications—those that generally used to treat or prevent chronic conditions—are being covered by employers under the deductible or are being paid for by the employee. Although there are federal guidelines in place to define which medications are considered preventive, the guidelines are subject to broad interpretation. As a result of the guidelines and perceived tax risks, Reynolds noted that “employers are being advised to just choose among pharmacy benefit management (PBM) lists and to not mess with them. Some may argue that PBMs need more, not less, employer/advisor input and oversight when it comes to what gets included and excluded from drug lists.”
Employers implement CDHPs because they help to contain costs while ensuring employee pushback is not too great, according to the survey. However, some respondents noted that CDHPs could reduce treatment adherence or result in care avoidance. Some patients—particularly those with lower incomes or a high health care need—may be incurring the biggest brunt of high out-of-pocket costs associated with CDHPs, even if that result is not showing up in employers’ data.
In addition to Reynolds, webinar speakers include Benfield Consultant Laura Rudder and NPC Director of Health Services Research Kimberly Westrich.