RxBenefits Survey: Nearly Half of Americans (49%) Have Experienced Challenges Obtaining Specialty Medications

New survey data underscores the challenges posed by the rise of costly specialty drug utilization, and showcases consumer preferences as they relate to medication coverage via an employer-sponsored benefits plan

RxBenefits, the employee benefit industry’s technology-enabled pharmacy benefits optimizer (PBO), announced results of a new survey designed to better understand consumer use of specialty medications — as defined as high-cost prescription medications prescribed by a physician used to treat complex, chronic conditions — as well as preferences around Rx coverage via an employer-sponsored benefits plan. The survey was conducted online within the United States by The Harris Poll on behalf of RxBenefits between June 24-28, 2021, among 2,013 adults ages 18+.

Notably, the survey found that 73% of Americans are currently covered by an employer-provided health benefits plan with prescription drug coverage, with 80% stating it is important that their current or future employer-provided health benefits plan will cover the cost of their — or their family members — specialty medications. If coverage is not provided by their employer-provided health benefits plan, more than one in ten Americans say they would involve their company’s HR department (16%) or change jobs (11%) to get coverage of their specialty medications.

With both the cost and utilization of specialty drugs increasing year over year, many employers have begun to evaluate new methods to reduce the growing impact on their healthcare costs. Despite proven successes with utilizing an independent prior authorization program and a variable copay program, two methods increasingly being explored include specialty carve-out, or excluding specialty drugs from the pharmacy benefit altogether.

“Specialty drug utilization continues to increase, and is showing no signs of slowing down. In fact, specialty medication costs accounted for over 50% of the total pharmacy spend incurred in 2020. While specialty carve-out has often been touted as an effective method to contain costs, the approach is not effective for employers and can actually cause severe member and service disruption,” said Bryan Statham, Chief Executive Officer, RxBenefits. “In today’s market where talent acquisition is highly competitive, it’s clear that employers must go beyond simply providing a paycheck to attract and retain talent. Providing a rich benefits package while keeping costs in check is one way to achieve this, which ultimately results in a healthier bottom line and a happier workforce. However, it needn’t come at a huge expense to self-funded employers.”

Additional survey findings include:

  • Of the 49% of Americans who have experienced challenges or roadblocks obtaining their specialty medications, the top challenge experienced was the overall cost of the medication being too high (24%), followed by 16% stating the medication not being covered by an employer-provided health plan
  • Americans ages 18-44 were more likely than those ages 45+ to say they would change jobs to get coverage if their employer-provided benefits did not cover the cost of their — or a family member’s — specialty medications (19% vs. 5%)
  • Americans ages 18-44 are more likely than those ages 55+ to say they would involve their company’s HR department to gain coverage (21% vs. 10%)

“The results of this survey further showcase just how important medication coverage is to today’s consumers. And while the benefits landscape can certainly be complicated, employers need an advocate that watches out for their financial interests as well as the best health of their employees — someone that helps them understand when something is right and when it’s not,” said Mark Campbell, PharmD, Vice President of Clinical Solutions for RxBenefits. “That’s where a PBO comes into play. At RxBenefits, we are dedicated to helping self-funded employers navigate the complex specialty medication landscape while ensuring their employees have access to the medications and treatments they need. Knowing consumers are willing to change jobs to secure medication coverage, it’s imperative employers identify ways to reduce the cost of pharmacy benefits without reducing value and care for employees.”

Most employers significantly overpay for pharmacy benefits while receiving suboptimal clinical management and customer service. RxBenefits’ PBO model provides benefits consultants and their self-insured employer clients a seat at the negotiating table regardless of their size, a data-driven clinical approach and high-touch, personalized service, substantially reducing costs while increasing value and improving member health. The model reduces pharmacy spend by more than 25% the first year, on average, and insulates the plan against future drivers of trend, like specialty medications.

For more information about RxBenefits and its industry-first PBO model, visit www.rxbenefits.com/pbo.