Significant price surges for insulin products have been causing sticker shock for individuals purchasing from the open market to help survive their Type 1 Diabetes. The most recent price increases can be devastating to any person without a health plan or self-funded employer group offsetting their out of pocket costs.New products are coming onto the market at $100,000 per year price tags.
While an individual with a pharmacy benefit plan is shielded somewhat from escalating prices of insulin, they are instead finding increases in their health premiums. Moreover, if the health plan member has opted for the high deductible choice for their medical/pharmacy benefit, those surging costs may be felt sooner than later.
In the middle of all of this is the PBM negotiating one manufacturer against the other with formulary exclusions and by market share promises that insinuate themselves into a position to rake in contracted, but not necessarily shared, discounts.
How can the pharmacy benefit health plan mitigate these rising cost trends?
With APC in your corner monitoring PBM choices, contracts, and ongoing service, the health plan with a self-funded pharmacy benefit can utilize strategies to share in the push and pull of market forces along with a savvy benefit manager. Take advantage of what we know to help your plan navigate a complex benefit.
