Employee Health Promotion

Having even one problem drinker on your health plan – including a covered family member with abuse issues â.” can cost your organization big.

Some estimates place the potential cost as high as $35,000 a year per case. What’ your company’s risk?

Many wellness programs are geared toward managing employees’ health risks associated with diseases like diabetes or asthma.

But unless the wellness program is integrated with an staff member assistance program (EAP), chances are alcohol abuse-related risks go undetected. Here are two strategies that’re getting good results.

1. Include alcohol in medical testings

When you already sponsor confidential worker health-risk assessments, it’s easy to screen for alcohol risks, too. This could be as simple as making sure three questions are added to the current appraisal -

o  Just how often do you’ve a drink containing alcohol?

o  How many alcoholic drinks do you’ve on a typical day? And

o  Exactly how often in the last month have you’d six or more drinks?

For male workers, more than 14 drinks per week, or one or more episodes of heavy drinking suggests a possible problem. for women, more than seven drinks in a week, or one or more episodes of drinking four or more drinks, is a red flag.

Alternative – When you don’t offer appraisals, you are able to refer personnel to a free, confidential online screening.

Benchmarking tools

A lot of specialists say drug-free worksite policies and employee assistance programs (EAPs) are the two most proven solutions within companies’ grasp for minimizing the risks and costs of alcohol abuse by health plan enrollees.

To see if sponsoring an employee assistance program (EAP) makes financial sense, you are able to calculate your own firm’s current cost risk for free here. Plug in your corporation type, locale and number of workers.

You’ll get a customized estimate of annually direct (absenteeism, disability, ER visits) and indirect (presenteeism, turnover) costs from alcohol misuse by a covered staff member or family member.

To design a drug-free worksite policy â.” or check if your existing one is up to par and compliant with the law – more guidance is available here.

It’s easy to feel like your PBM holds all the power over you. In most cases, it does.

A landmark 2004 study compared what pharmacy benefits managers (PBMs) charge businesss’ plans to what they actually pay pharmacies.

Researchers found staggering overcharges – in particular for generic drugs. Regretfully, four years later, the situation has hardly changed. All too often, PBMs improve their own bottom line at the expense of the plan sponsor’s.

Chances are, it’s your health insurance provider – not yourself – who contracts with the PBM to administer the prescription drug portion of your health benefits.

So how can you feel confident your firm is getting the best value and service? Begin by asking your health-plan broker these four questions about the current or prospective PBM.

1. Precisely how does the PBM calculate price?

A lot of PBMs gain hidden profits off your plan through a practice called “differential pricing,” says consultant Gerry Purcell.

In other words, the PBM pays one price to drug retailers and then sets a lesser discount off the typical wholesale price (AWP) for your company’s plan. Example -

o  The PBM compensates the drugstore the AWP minus 18%

o  your plan and staff pay AWP minus 15 percent for meds, and

o  The PBM pockets the difference.

Now for some good news. You do have some leverage in this area. If your drug plan is covered underneath the ERISA umbrella, the PBM must disclose this info.

Ideally, you’ll find the rates are the same on both contracts. But when there’s differential pricing, insist your firm get the full discount.

2. What’s the PMPM?

One key cost figure PBMs can’t manipulate is the per-member-per-month (PMPM) cost of your plan. This number will show when your plan’s costs actually increased or decreased.

The PMPM is calculated by dividing the total costs spent by the number of staff members enrolled in the drug plan.

It’s also a excellent tool for comparing different PBMs to see which is the most cost-efficient for the size of your organization, says Peter Reed of Managed Benefits Strategies.

3. can we get rebates, too?

Some PBMs receive money from drug organizations that your brokers won’t tell you about – but could  be able to leverage to your plan’s advantage. Example – Many PBMs get rebate checks from drug organizations (typically 50 cents to $1.25 per claim) for assisting increase the sales of their products.

When you push hard enough for it, your broker may able to work an arrangement where you either -

o  split rebates from your plan evenly, or

o  let the PBM keep the entire rebate in exchange for a price break on administrative fees.

Important –  Ask to figure out all the payment types the PBM gets from the drug firms. Rebates are often couched in the form of grants or classified as access fees or formulary fees.

4. Exactly how do changes in the formulary work?

In most states, PBMs can change your plan’s list of approved medications without prior notice.

The problem –  PBMs often make mid-year switches that save them money, but may not save your corporation or employees a dime.

Example – If the PBM adopts a mail-order-only coverage policy on a certain formulary drug, an employee who needs same-day access to the medication might  be forced to pay full price for it at a drug store.

Meanwhile, your plan is still charged the formulary price.To avoid such unpleasant surprises, insist the PBM give written notice of formulary changes, including the addition of new generics.