Audiotape and written materials of AIS's audioconference on October 29, 2003

How to Structure Pharmacy Benefits In Consumer-Directed Health Plans

Plan design is everything when structuring pharmacy benefits in consumer-directed health products. Yet many MCOs, PBMs, brokers and employers have no experience structuring a pharmacy benefit when pharmacy usage is driven from the bottom up ... and traditional benefit structures no longer work.

Sponsored by Inside Consumer-Directed Care, AIS's biweekly newsletter with news and analysis of benefit design, contracts, market strategies and financial results.

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Two of the nation's leading experts on pharmacy and consumer-directed care provide valuable insights into the latest strategies being used to incorporate pharmacy into CDH plan design. No theories and hypothetical examples here. Just real-life examples and solid solutions — direct from the field — about which plan designs are most effective and which to avoid.

Consumer-directed plans and pharmacy benefits both are changing at a frenetic pace ... and many complex big-dollar questions exist at the intersection of these two fields.

One example: In CDH plans, making traditional coverage choices on the pharmacy benefit can defeat the purpose. For instance, moving the pharmacy benefit to 80% coverage under a CDH plan can actually drive up drug costs. Learn how the right plan design will help you sidestep these and other potential pitfalls.

• Why efforts to micromanage the Rx benefit under a Health Reimbursement Arrangement (HRA) is a recipe for failure.
• Why tiered pharmacy benefits cannot work under the CDH model.
• How the principle of physicians determining the best medication for patients may be changing under the CDH model.
• How to avoid payment coordination problems when you allow members to use HRA dollars for prescriptions.
• Why employers need to restrict HRAs to prescription (as opposed to OTC) drugs.
• Why "step therapy" has become critical to CDH plan design.
• How the right CDH plan design can spur patients to switch prescriptions to less-expensive alternatives.
  

• Managed care and insurance company product managers
• Insurance brokers
• Pharmacy benefit managers
• Pharmaceutical company executives and marketers
• Managers of hospitals and other provider organizations
• CFOs and business managers of employers
• Employee benefits directors
• Marketing directors at CDH and related vendors
• Human resource VPs
• Attorneys and consultants
• Actuaries

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