Access to fair prescription plans can make employees healthier

While some employers may worry about the current negative focus on workplace diversity, equity, and inclusion efforts, pharmacoequity is different.

Pharmacoequity, as a component of broader workforce health equity efforts, strives to ensure that every employee can get affordable and accessible, high-quality care for their health issues.

Related: Reducing workforce health and well-being inequities is good for business

The business case for pharmacoequity yields two sources of value.

First, more equitable use of medications can result in improved chronic condition management and enhanced health, with the promise of lowering overall healthcare expenditures.

Second, employees who feel that their organizational leadership cares about their health and well-being are more likely to be engaged and contribute more to organizational success.

As a result, it makes sense for employers to understand and address inequities in medication use among their benefits-enrolled workforce and family members.

Causes of Prescription Usage Gaps

Why do variations in medication use occur?

Many potential reasons come to mind.

Employees may face barriers to medications due to access concerns (pharmacy deserts or transportation challenges), affordability concerns, or other issues, including medical mistrust or health literacy concerns that limit their regular use of medications.

Employers may unknowingly adopt benefits designs that are costly for low-wage workers, such as high-deductible health plans, where out-of-pocket costs for medications may be significant, without significant employer contributions to health savings accounts or health reimbursement arrangements.

Reduced medication use may also occur in the absence of a trusting patient-clinician relationship, where individuals may have doubts or uncertainties about the need for the medications that have been prescribed for them.

Employers can use pharmacy benefits claims data to understand if inequitable medication use is occurring among their benefits enrollees.

Analyzing medication adherence rates by comparing enrollees in different racial or ethnic subpopulations or wage categories may reveal meaningful differences.

For example, in a population of 45,000 employees, in addition to the reported wage-based differences in healthcare use, we also showed that low-wage workers had a 19% lower use of medications for treatment of common chronic conditions.

While pharmacy benefits claims data analysis may provide evidence of inequities in medication use, it can be difficult to identify the root cause or causes for the observed findings.

Employers can work with their PBMs, explore the issue with employee resource groups, or survey employees to learn more.

With a better understanding, employers can then develop targeted solutions and measure their impact.

Possible Solutions

Employers have a number of options they can use to improve medication adherence and pharmacoequity among employees.

Typical employers have already taken steps to incorporate tiered pharmaceutical benefit plans to encourage enrollees to use lower-cost medications.

Employers have also incorporated value-based insurance designs to lower patient out-of-pocket costs for high-value medications.

Most employers with high-deductible health plans have also implemented pre-deductible coverage for specific medications used for chronic condition management, thereby lowering out-of-pocket enrollee costs.

Here are other options employers can implement:

◆ Wage-based benefits subsidies for low-wage workers can help to make medications more affordable. Subsidies may be provided in many forms to low-wage workers, including reduced monthly premiums, lower deductibles, or greater HSA contributions.

◆ Allowing enrollee use of manufacturer coupons to count toward enrollee deductibles, thereby lowering enrollee out-of-pocket costs (no copay assistance accumulator programs or copay maximizer programs).

◆ Alternative care delivery models may be particularly helpful in settings where access to healthcare is limited. Telehealth, on-site, or near-site clinics may improve employee access to care and may result in enhanced medication use.

◆ Alternative PBM models may also help to focus attention on — and support for — enrollees with low medication adherence rates.

◆ Terms in employers' healthcare contracts can prompt PBMs and health plans to provide data regarding pharmacoequity measures.

A vendor strategy for addressing any identified inequities in medication use may also be helpful.

Transparency in the reporting of inequitable medication utilization or adherence rates can provide a basis for employers to hold vendors accountable for observed inequities.

A similar approach regarding healthcare services use is already in use by some employers.

The Bottom Line

Improving the management of chronic conditions can help organizations manage their health benefits expenditures.

This is particularly true for conditions including diabetes, hypertension, and high cholesterol.

Poorly managed conditions are associated with a greater risk of complications, including heart and vascular disease, as well as stroke and kidney disease.

An equitable approach to prescription medication use — or pharmacoequity — can help minimize the risk of these complications, resulting in likely improvements in both employee health and business outcomes.

Bruce Sherman, MD, FCCP, FACOEM, is a faculty member at the Case Western Reserve University medical school, medical director of the North Carolina Business Coalition on Health and a consultant at the National Pharmaceutical Council. Brian Sils is a consultant at the council, and Kimberly Westrich is the council's chief strategy officer.