Benefits managers say poor health behavior is the greatest contributor to health plan costs. Members' decisions led to more than $317 billion of avoidable medical costs in 2011, according to a report from Express Scripts released Thursday.

The fifth annual "9 Trends in Rx Plan Management" states that behavior-driven decisions have three times the impact on costs as health reform, new medications, biosimilars and electronic medical records combined.

The report polled benefits managers from 318 organizations. While only 58 percent of respondents report that they currently use a wellness plan, 81 percent say they intend to offer one in the next two years.

"This is a broad acknowledgement of how critical addressing behavior is to reducing health care costs," said Tim Wentworth, senior vice president and president, sales and account management, Express Scripts in a statement. "A vast majority of our clients are now focusing on improving the health behaviors of plan members. This is critical, especially at a time when rising health care costs, waste from medication nonadherence and suboptimal health outcomes are making it harder to provide a robust pharmacy benefit."

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