While most employers may equate increased drug use with higher costs, it looks like the latest study might prove them wrong.
EmpiRX, a pharmacy benefit manager, has found that behavioral health medications lead to nearly a 10% increase in pharmacy claims for their clients. But while the use of drugs for Mental Health the needs have increased in recent years, but not the employer’s charges. In fact, EmpiRX saw an almost 5% drop in plan spend per user – in other words, employers saved money despite employees seeking more pharmaceutical care.
“It depends on our model,” says Karthik Ganesh, CEO of EmpiRx Health. “We’re moving from more expensive drugs to clinically appropriate but less expensive drugs. We’re not allowing patients to take multiple drugs that work against each other. We’re buying for value, not volume.”
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EmpiRX is a value-based PBM, meaning they only make a profit if they save the employer money in a given year. Ganesh warns employers to beware of traditional PBMs, which often offer discounts with no guarantee of lower overall spending.
“The only way for a PBM to work with a manufacturer and get bigger discounts is to promise the manufacturer more volume,” says Ganesh. “We have a healthcare system that is heavily driven by volume because more patients and more utilization generally means more money. But we have completely lost sight of the fact that more is never better.”
A study published in the Journal of the American Medical Association found that 25% of healthcare spending, or nearly $1 trillion, is wasted due to factors such as poor coordination of care between health care providers. health, excessive treatment and unnecessarily expensive drugs. Ganesh and his team strive to minimize this waste for their clients by connecting with doctors to identify the most cost-effective drugs for its members.
“It’s not just us who arbitrarily say what a patient needs,” says Ganesh. “We’re the ones working with physicians and finding out what a patient doesn’t need, and lower cost alternatives. We can get a multitude of answers.”
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It has made all the difference in employer health plans and employee health. EmpiRx data also revealed a 93.5% medication adherence rate, meaning employees can afford to take the medications they are prescribed. Notably, EmpiRx’s antidepressant use increased 12% while gross spend per claim fell nearly 2%, and ADHD medications increased 20% while recording a 9% drop in gross expenses.
However, more use is not always good. Drug overdoses have increased by almost 30% in 2021, with opioids responsible for the majority of deaths. EmpiRx, on the other hand, reported a 10% reduction in opioid use in the same year. Additionally, the PBM noted a 14% increase in the number of patients seeking treatment for an opioid use disorder.
“Our healing model is essentially hand-to-hand combat,” says Ganesh. “Our clinicians work directly with patients to ensure they are adhering to their medications or seeking appropriate treatment. But it is always heartwarming to see our patient base asking for help.”
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Ganesh stresses that meeting mental health needs in the face of the pandemic is particularly vital for EmpiRx. He predicts that the struggles with anxiety and isolation will continue and usage rates are not expected to falter. Ganesh emphasizes that hesitation to act will only make things worse. According to the American Psychiatric Association, the US economy loses more than $200 billion a year in absenteeism, reduced productivity and medical costs associated with untreated mental illness.
Ganesh encourages employers to challenge their benefits advisors and rethink their relationship with the pharmaceutical industry. Employers may not be able to maintain the status quo.
“As a society, we should step up and support anyone who is facing a challenge from a mental health perspective,” he said. “It’s the right thing to do as human beings, but it’s also the right thing for everyone’s pockets.”
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