Why Employers Are Turning to High Deductible Medical Plans

Posted October 04, 2012 by

Amy Kaminski of Compdata SurveysAccording to the Kaiser Family Foundation, Americans filled more than 3.7 billion prescriptions in 2010. Because the rate at which individuals developing chronic health conditions continues to increase, the expected decline in drug costs comes as little comfort to hospitality employers who are largely footing the bill, as an overwhelming majority still offer prescription coverage to employees as a part of their medical plan. These increasing costs translate to higher premiums for employers and employees, as well as increasing co-pays.

“In the hospitality industry, prescription drug co-pays have been trending upwards on most plan types over the last few years,” said Amy Kaminski, director of marketing for Compdata Surveys. “On PPO plans for example, formulary co-pays have increased 14.8 percent since 2009, while non-formulary co-pays have gone up by 15.2 percent.”

Formulary drugs are medications included on a list of preferred medications issued by the insurer. Drugs not on this list are referred to as non-formulary and generally incur higher co-pays and may require pre-authorization from the insurer before coverage is granted.

The use of value based insurance design (VBID) has made headlines lately as a means to control prescription costs. Using VBID, services and treatments are priced based on the overall value to an individual’s health, so the greater the value the lower the cost. As a result, co-pays on medications for chronic conditions, such as high blood pressure or diabetes, may be reduced or eliminated completely. The assumption being that reduced out-of-pocket costs will encourage employees to continue taking needed medications, keeping them healthy and reducing long-term medical costs to the employer.

Many organizations are turning to high deductible health plans (HDHP) as a means to control costs. In 2012, 11.6 percent of hospitality employers offered HDHPs. Because HDHPs carry a higher deductible, the premium costs are generally reduced. Ninety-seven percent of hospitality employer sponsored HDHPs include prescription coverage, with 95.1 percent of those reporting a co-pay requirement. The average formulary co-pay under an HDHP is $32, with non-formulary co-pays averaging $47. Generic drug co-pays on these plans are the least expensive at $11.

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