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Prescription For Wellness: Harnessing Your Pharmacy Data To Improve Employee Health And Productivity

Pharmacy costs are skyrocketing and comprise a substantial portion of health care dollars. The price of brand-name prescription medicines rose more than 13 percent on a year-over-year basis as of September 2012, according to the Express Scripts Drug Trend Quarterly Spotlight. This marks an increase that is six times higher than overall price inflation for other consumer goods. With new specialty drugs hitting the market every year, managing your pharmacy costs is more important than ever.  Having a comprehensive understanding of how to manage drug costs can not only save your company money, but it can also strengthen your wellness programs.

Pharmacy claims costs have previously been considered a burden, but that same data could be the key to putting employees on the right path to managing their own health.  Wellness programs, also known as population health management programs, have identified prescription drug claims data as a real-time, accurate source of information to identify employees with chronic conditions who have potential for treatment or lifestyle modifications that may improve their outcomes.  Pharmacy data is more vital to successful population health management than any other data source (as determined by the Society of Actuaries in 2007).

The old 80/20 rule applies in this discussion. Employers, carriers and wellness vendors know that less than 20 percent of the population drives 80 percent of healthcare costs. These folks typically have chronic diseases and are not always compliant when it comes to prescription drug usage and making healthy lifestyle choices. Using prescription drug data to identify non-compliant patients early in their treatment plans is a game changer in term of influencing behavior and reducing claim costs.  The most sophisticated population health management companies figured this out a long time ago, and their case studies highlight the critical nature of leveraging pharmacy data to customize programs that identify, coach and create effective behavior modification plans for the individual employee.

Let's face it - if employees are unhealthy, they typically do not feel well, which leads to lower productivity and higher instances of absenteeism.  Employers realize they must provide their employees an opportunity to make real change in their lives.  Identifying high-risk employees with a proven predictive modeling tool and providing them meaningful engagement tools and experienced coaches, will become the premiere way to track high cost employees and create actionable intervention strategies. Using an agnostic wellness vendor who can conduct progressive claims analytics on employer Rx data is the new must-have.

So, what can you do to start harnessing the power of your company's pharmacy data?  Carve out time and work with your HUB consultant to provide proper resources for your wellness vendors.  Expect real-time solutions, but ask the right questions. Evaluate your carrier and PBM partners. If an employer is self-funded, a true partner will have the same goal of containing costs and will provide pharmacy claims data to your wellness vendor. 

If accessing pharmacy data can help create and strengthen a company culture of healthy, productive employees and savings opportunities, it's clear that utilizing this information should be a priority for every business.

 Annette Dowdle, RHU, CCWC, is Senior Vice President of HUB International Gulf South and a member of the HUB National Employee Benefits Executive Team.  Learn more about Annette at