With pharmacies moving prescriptions from a 90-day to a 30-day supply there are many considerations for plan sponsors. Benefits Canada outlines some of these in their latest article. In it, Suzanne Lepage reminds us that “It’s worth making sure that plan members are not penalized because of a new mandate that’s out of their control.” While plan sponsors are currently benefiting from premium relief on low utilization benefits such as vision and dental, they should be preparing for higher than usual drug claims.
Drug costs will increase as a result of the 30-day supply, how much will vary from group plan to group plan. Let’s say you have 3 monthly scripts, the pharmacy charges about $10/script in disp fees every three months, or $30. Now, that cost has tripled to $90/3 months.
The 30-day supply could also have a negative affect on plan member adherence to their prescriptions, which we know has a negative affect on claims and overall health outcomes.
The 30-day supply isn’t the only way that drug usage is increasing. This early US-based data found that prescriptions for mental health conditions such as anxiety have increased by 21% since COVID-19. Other plan features that we should keep an eye on are PPNs and drug formulary flexibility if/when a drug shortage happens.