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  • Health care costs in the United States have been steadily climbing, and the burden on employers providing health care benefits for their workforce is intensifying year by year. A recent report by Aon forecasts a looming challenge: average costs for employers covering their employees’ health care are projected to surge by 8.5% in 2024, amounting to over $15,000 per employee. This steep rise marks a concerning trend, nearly doubling the previous year’s increase of 4.5%, setting off alarm bells for companies navigating their health care budgets.

    Driving Factors Behind Escalating Costs

    Let’s take a look at three pivotal elements that are steering this surge in health care expenses.

    Inflation: The silent aggressor

    Inflation, accounting for roughly half of the cost hikes, substantially impacts health care expenses. The health care sector experiences a delayed effect due to multi-year provider contracts. Renewals in these contracts are causing providers to demand higher fees, thereby stretching the impact of inflation over several years.

    COVID-19’s lingering impact

    The aftermath of the pandemic continues to cast a shadow over health care costs. Medical utilization, which plummeted during the peak of the pandemic, is now reverting to pre-COVID levels. This resurgence in medical usage is a driving force behind the escalating health care expenditures for employers.

    Surging prescription drug costs

    Prescription drug expenses are spiraling at an alarming rate, surpassing the growth rate of medical costs. The use of specialty drugs such as GLP-1 and medications initially designed for diabetes, which are now being utilized for weight loss, have doubled between 2022 and 2023.

    Navigating The Way Forward

    The tight labor market continues to discourage passing higher health care expenses onto workers. However, future projections indicate an inevitable shift towards significant changes in employee contribution as employers prepare for 2025. Employers are creating strategies to manage costs, including targeted plan adjustments to address expensive medications and treatments. In addition, a shift in vendors is anticipated to secure better prices and discounts on health care services. The focus on mental health services is also expected to intensify, acknowledging the importance of employee well-being.

    How PEOs Are Revolutionizing Employee Benefits

    In the face of these health care cost escalations, employers find themselves at a critical stage where innovative solutions are imperative. The strain of balancing employee well-being with financial sustainability requires a strategic approach. This makes the role of Group Management Services, a certified professional employer organization (CPEO), crucial. GMS extends a lifeline to businesses, offering access to various benefits through our master health care plan (MHP). Through pooled resources, negotiated rates, and streamlined administration, GMS enables companies to combat increasing health care expenses effectively. By leveraging GMS’ buying power and expertise, businesses can navigate these unprecedented times and provide quality health care benefits to their employees while maintaining a competitive edge in the marketplace. Get a quote from us today and end the open enrollment period on a high note.

  • In an era marked by unprecedented health care challenges and changes, one issue that has been steadily making headlines is the rise in prescription drug costs. Employers, in particular, are feeling the financial pinch as they grapple with the ever-increasing expenses associated with providing prescription drug benefits to their employees. Recent data indicates that the median annual price of new drugs surged from $180,000 in 2021 to a staggering $222,000 in 2022, marking a 23% increase. In addition, the costs of existing drugs also saw a significant spike of more than 25% in just one year.

    Despite these statistics, there’s hope on the horizon. Employers can adopt innovative strategies to effectively manage prescription drug costs while ensuring that their employees receive the medications they need. If you’re a small business owner, continue reading to explore ways to navigate this challenging trend and make informed decisions to protect your employees’ health and bottom line.

    Leverage Technology

    One of the fundamental steps in controlling prescription drug costs begins with employees. Even the most well-designed prescription drug plans can’t deliver on their promise if employees don’t fully understand them or don’t adhere to prescribed drug regimens. Educating employees about their coverage and available alternatives is essential. Employers can utilize apps and technology to provide alerts and prompts when drug prices rise, allowing for discussions for more cost-effective alternatives with health care providers. In addition, monitoring and improving adherence to care plans and drug therapy requirements is crucial, as non-compliance not only drives up costs but also poses a threat to employees’ health.

    Carefully Manage Plans

    Employers, especially those with self-funded health benefits, have opportunities to manage costs more effectively. They can negotiate contracts, define drug formularies, and seek ways to maximize rebates from drug manufacturers. Smaller and fully insured employers should work closely with health insurance carriers to manage formularies and tighten authorization requirements, ensuring that only those needing specific drugs can access them. Employers should consider steering patients toward biosimilar and generic drugs when clinically appropriate, always weighing the net cost and the best clinical choice for the patient.

    Select The Right Partners

    Selecting the right partners in the management of prescription drug benefits is paramount. Employers should ensure that their partners’ priorities align with their goals. For instance, an insurer offering a fully insured prescription drug plan to a smaller employer will focus on controlling formulary costs. Employers must also prioritize efficient prior authorization processes, ensuring they don’t disrupt patients’ clinical care and treatment timelines. In today’s evolving landscape, employers have the opportunity to partner with third parties, such as professional employer organizations (PEOs), to assist with these rising costs.

    The Help Of A PEO

    In the current economic climate, businesses face an uphill battle with ever-increasing expenses. From the mounting health care and prescription medication costs, entrepreneurs and business owners are navigating a complex financial landscape. However, there’s a solution that can offer significant assistance in tackling these challenges – GMS, a professional employer organization (PEO). GMS comes equipped with Rx Specialists who can provide invaluable guidance in optimizing health care plans, controlling prescription drug costs, and ultimately reducing the financial strain on business owners.

    Christine Rohrer, GMS’ Rx Coordinator, added, “To help with the rising cost of medications, Rx Coordinators at GMS will provide support for members who need additional help accessing medications that may have a high copay, require a patient assistance, and/or are excluded such as specialty medications. If needed, the Rx team will look at the members’ diagnosis to discuss treatment options with providers. We also investigate and research future drug trends, search for medications that are covered through medical, and/or discuss switching medications to a covered, cheaper alternative that is on our formulary. We will look through every available option and take on a hands-on approach to ensure our members have access to life-changing medications.”

    By partnering with GMS, business owners can not only ease the burden of rising expenses but also direct their energy towards the core goal of their business: growth and success. In times of financial uncertainty, PEOs can be the sturdy bridge that supports your business. Contact our HR experts today.

  • On August 12th, 2022, the Inflation Reduction Act went into effect. As inflation continues to rise throughout the United States, the act calls for a significant reduction in prescription drug pricing. Various implications come along with the new federal drug price as it moves across healthcare systems.

    Three Provisions

    A recent webinar panel discussed three major changes in prescription drug pricing:

    1. Price negotiation – This allows the government to regulate certain drugs under Medicare and the Drug Price Negotiation. This pushes the government to establish a maximum fair price (MFP) for certain prescription drugs. As a result, H.R. 3 requires the Secretary to consider research and development costs, market data, production and distribution costs, and therapeutic alternatives. 
    2. Inflation penalties – Pharmaceutical manufacturers must pay rebates on drugs covered by Medicare Part B and Part D if the drug price rises faster than the inflation rate. 
    3. Medicare Part D – This creates a $200,000 out-of-pocket cap on Part D prescription drug spending. 

    Industries Affected

    Due to the creation of this revision, there are five key sectors of the healthcare system that are affected, including: 

    • Drug manufacturers 
    • Payers
    • Providers
    • State Medicaid agencies
    • Patients

    Deduction Of Manufacturer’s Revenue

    Drug manufacturers not subject to negotiation will see a decrease in revenue as others choose to decrease their prices. Due to inflation caps, price increases will be limited. A significant benefit of these regulatory changes will be a smaller out-of-pocket cost for consumers.

    Medicare Part D Cap

    The regulations have established that Part D beneficiary premiums are capped for 2024 through 2029. In addition, there will be an annual beneficiary cost-sharing cap effective in 2025. This will also eliminate catastrophic beneficiary cost-sharing for 2023 and 2024. The negotiated drug prices and inflationary rebates may reduce Medicare Advantage plan costs for Part B drugs.

    The Impact GMS Has On Your Business

    As a business owner, you want to ensure that your benefits plan continues to get you the lowest rates. When you partner with GMS, you gain access to an Rx Specialist who can support you and your employees find the most cost-effective option. Additionally, we offer control of premiums, access to data and networks, and options you can’t find elsewhere. Learn more today!

  • The cost of prescription drugs in the United states continues to rise which has become a source of concern for everyone from patients to policymakers.  According to a study published in the Journal of the American Medical Association (JAMA), “Prescription medications now comprise an estimated 17% of overall personal health care services in the U.S.”  

    We don’t want to think that we overpay for any goods or services. Taking time to do some research can help you save substantially on your prescriptions. Here are some tips to help save on costs.

    Image of costly prescription drugs. Learn tips to save on prescription drug prices.

    Take Advantage of Generic Drug Options

    Learn your prescription drug copays or co-insurance. Talk to your doctor about prescribing drugs that have generic equivalents. According to the U.S. Food and Drug Administration website, “When a generic drug product is approved, it has met rigorous standards established by the FDA with respect to identity, strength, quality, purity, and potency.” If your medication doesn’t have a generic form, or if it may not be covered under your prescription drug plan, ask your doctor for a generic alternative.   

    Consider Pill Splitting

    Many medications can be split, so talk to your doctor about doubling the strength (40mg instead of 20mg for example) and cutting the pills in half. You would then be charged for 15 tablets instead of 30. 

    According to Kevin Schulman, MD, Professor of Medicine and business administration at the Duke University Medical Center in Durham, N.C., “Sometimes it makes a lot of financial sense to split pills, but if you try to split the wrong sort of medications, that could be potentially dangerous.” So, this is a good option for some people, but as always, check first with your doctor to make sure if it can work for you. 

    Do Your Homework

    Shop around. Prescription drug prices vary from pharmacy to pharmacy, so if you have the time, take your prescription to more than one pharmacy to find the best price. This will help you if you have a high deductible plan with your out-of-pocket costs. 

    Try and Find Discount Cards

    Prescription discount cards sometimes provide even better discounts than what insurance can provide, especially on generic drugs. Websites such as www.goodrx.com and www.blinkhealth.com also provide drug discount information in your area. Pharmacies also have discount cards available.  

    If prescription drug prices are a problem area in your company, contact Group Management Services today. We can help you learn more about the coverage options we can provide for your employees along with our other outsourced HR services.