Many employers offer comprehensive health benefit plans, but without realizing it, these plans likely include features and requirements that can be barriers to accessing health care.
Workers across every demographic and every industry are reevaluating their relationship with their jobs. According to the U.S. Department of Labor, nearly 4.3 million people quit their jobs in January and there were 11.3 million job openings. The high level of resignations and open positions indicates a strong job market and ample opportunities for those seeking employment. Employers who are hoping to retain and attract talent should recognize they need to focus not only on higher pay, but also on the benefits workers want the most, such as flexibility and health insurance coverage.
Health care is often the most important benefit for workers considering a job offer, and some employees would take a job with lower pay if it offered better benefits. As many employees are rethinking their priorities, it's important for employers to show their talent how much they value them by offering benefit packages that put employee needs front and center, such as by controlling the out-of-pocket costs of prescription medications.
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Patricia J. Goldsmith is CEO of CancerCare. A frequent speaker at national meetings and symposia, Goldsmith was named in 2021 to Forbes Magazine's 50 Over 50 Vision List. In March 2022 CancerCare released a Toolkit that provides best practices and recommendations to help employers evaluate prescription drug benefit plans. Many employers offer comprehensive health benefit plans, but without realizing it, these plans likely include features and requirements that can be barriers to accessing health care. This sends a message that the employer cares more about saving a buck than helping them weather a serious health problem.
Insurance companies and benefits consultants often recommend cost-saving strategies to control patients' access to health care services—practices known as utilization management (UM). UM can look like an attractive element of a health plan, particularly since insurance companies claim UM saves money and results in better patient care. However, while UM is said to help insurers contain costs and ensure appropriate treatments, the administrative snarls, delays, and stress of UM can instead pose significant barriers to employees who need medical care, especially those with serious or chronic illnesses.
Although many UM practices seem benign, unintended yet harmful consequences may result from:
- Delaying, disrupting, or denying necessary and time-sensitive care
- Increasing out-of-pocket prescription costs, which can drive treatment non-adherence and result in worse health outcomes and higher medical bills
- Adding time-consuming and costly administrative burdens for patients and health care providers
- Creating barriers to receiving personalized care
- Devaluing what matters to patients regarding their care and quality of life
It is critical that employers take care to balance cost savings with the real needs of their employees. HR and benefits managers should learn about the unintended consequences. For example, out-of-pocket costs for prescription drugs can be staggering, causing patients to cut pills in half, skip doses, or abandon their prescriptions at the pharmacy. This "medication non-adherence" is estimated to cost the economy between $100 million and $290 million annually.
So, when insurance companies and pharmacy benefit managers propose policies, employers need to ask the right questions to ensure they aren't creating problems – and potential increased medical expenses — and are designing benefit packages that align with the values of their company.
Ultimately, a well-designed prescription benefit plan not only helps employees get the treatments they need when they need them, but helps their employer too. A strong benefit design can support productivity, help reduce long-term medical spending, attract and retain talented employees, and build satisfaction and loyalty.
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