Constance Sjoquist, Senior Healthcare Analyst with RazorMetrics

Constance Sjoquist，RazorMetrics的高级医疗分析师

Large employers report that the biggest threat to self-funding medical coverage is the increasingly high cost of pharmacy claims. In their annual Health Benefits Priorities survey, MBGH found that employers consider pharmacy costs extremely problematic. Ninety-one percent of employers cited million-dollar treatments approved by the FDA, and 89% pointed to specialty drug spending as a top threat.  .

大型雇主报告说，自助医疗保险的最大威胁是药房索赔成本越来越高。在他们的年度健康福利优先调查中，MBGH发现雇主认为药房成本问题非常严重。91%的雇主表示FDA批准了百万美元的治疗方案，89%的雇主表示特种药物支出是最大的威胁。  .

Source: PSG 2023 Trends in Specialty Drug Benefits Report

资料来源：PSG 2023特种药物福利趋势报告

Employers already pay too much for pharmacy; according to Kiplinger, drug costs will shoot up another 10% this year, the biggest increase in a decade. Employers are right to be concerned.

雇主已经为药房支付了太多费用；据Kiplinger称，今年药物成本将再上涨10%，这是十年来最大的增长。雇主有权关心。

The problem is that controlling drug costs is complex, and the primary efforts to lower the costs have centered around unpopular programs like prior authorization and employee-centered apps. Neither addresses the fundamental problem behind high drug spending – prescribers.

问题在于控制药物成本是复杂的，降低成本的主要努力集中在不受欢迎的计划，如事先授权和以员工为中心的应用程序。既没有解决高药物支出处方背后的根本问题。

The Commonwealth Fund pinpointed three main reasons why waste is built into the usual prescription process:

联邦基金会明确指出了将废物纳入通常处方程序的三个主要原因：

Physicians often don’t know the cost of medications; they simply prescribe them out of habit. Physicians say it takes too much time to figure out which drugs are within the formulary and which are lower priced. The process is frustrating for themselves, pharmacists, and patients.Because of misaligned incentives with the PBM and the employer, rebated drugs on the formulary may cost more than an equivalent drug used to treat the same condition.

医生通常不知道药物的成本；他们只是出于习惯开处方。医生说，弄清楚哪些药物在处方集中，哪些价格较低需要太多时间。这个过程对他们自己，药剂师和病人来说令人沮丧。由于与PBM和雇主的激励措施不一致，处方集上的回扣药物可能花费超过用于治疗相同病症的等效药物。

In addition, the full discount of the rebate may not be going to the plan and the employee, raising costs for both. Price “spread,” which is the delta between what they spent on medicine and what they charged the self-insured employer, also adds cost. This spread delta grows as the drug cost goes up. Employers do not want to risk upsetting employees, so they allow low-value, high-cost drugs onto the formulary, which then get prescribed.

此外，回扣的全额折扣可能不会进入计划和员工，从而增加两者的成本。价格“传播”，即他们花在药物上的时间与他们向自保雇主收取的费用之间的差额，也增加了成本。随着药物成本的上升，这种扩散三角洲也在增长。雇主不想冒险让员工感到沮丧，因此他们允许低价值，高成本的药物进入处方集，然后处方。

Some of these drugs include:.

其中一些药物包括：。

“Me-too drugs”: Basically, the same drug formula as the original but with inconsequential differences to extend patent protection.“Combination drugs”: Creating a new patent by combining two active ingredients into one pill.“Brand-name drugs”: Using the brand version when a lower-priced version is available..

“我也是药物”：基本上，与原始药物配方相同，但差异不大，可以延长专利保护。“组合药物”：通过将两种活性成分组合成一片药丸来创建新专利。“品牌药”：当价格较低的版本可用时，使用品牌版本。。

To date, employers have tried many strategies to control drug costs – mainly by placing the burden on their employees. They assume that by giving employees more information and more tools, they will get lower-cost prescriptions. But this tactic doesn’t necessarily guarantee savings. When offered health apps to find lower-priced drugs, few employees use them.

迄今为止，雇主已经尝试了许多控制药物成本的策略-主要是通过给员工带来负担。他们假设通过为员工提供更多信息和更多工具，他们将获得更低成本的处方。但这种策略并不一定能保证储蓄。当提供健康应用程序以查找价格较低的药物时，很少有员工使用它们。

These apps introduce the need to download, register, research, and essentially do their physician’s job – making prescribing decisions!.

这些应用程序介绍了下载，注册，研究以及基本上完成医生工作的必要性-做出处方决定！。

The net result is that employees feel overwhelmed with all the “help”: they simply want their doctors to prescribe lower-priced medications when they are available.

最终结果是员工对所有“帮助”感到不知所措：他们只是希望他们的医生在可用时开出价格较低的药物。

Employee Experience: Role confusion.

员工体验：角色混乱。

“I feel bogged down researching alternative medications, figuring out how much they cost, determining which pharmacy has it, what each one charges, and on and on. Why am I doing the homework? Isn’t this why I am paying the people who went to med school?

“我觉得陷入了研究替代药物的过程，弄清楚它们的成本，确定哪家药房有它，每家药房收费什么，等等。我为什么要做作业？这不是为什么我要支付那些去了医学院的人？

Employee experience: App frustration.

员工体验：应用程序挫折。

“I had a hard time with the prescription app. I am taking six medications, and it takes a lot of time to go through each one. Each medication has three or four different options, and I don’t really understand the choices. I decided not to use the app and just call the pharmacist.”

“我很难使用处方药，我正在服用六种药物，每种药物都需要很多时间，每种药物有三到四种不同的选择，我真的不明白这些选择，我决定不使用该应用程序，只叫药剂师。”

Employee experience: Information overload.

员工体验：信息超载。

“I have health apps through my plan, and they all communicate A LOT. I’ve tried to turn off alerts. I can’t figure it out. The apps don’t communicate with each other or my health plan. There is too much coming at me. I am just one me. I want my plan to make this easier and bring my health information from all these disparate places together and manage it.

“通过我的计划，我有健康应用程序，他们都沟通很多。我试图关闭警报。我无法弄清楚，这些应用程序彼此不沟通或我的健康计划。来我的太多了。我只是一个人。我希望我的计划让这变得更容易，并将来自所有这些不同地方的健康信息汇集在一起并进行管理。

Then, alert me once without trying to force me to do something. All these reminders! I feel bullied constantly. If my insurance and doctor could take something off my plate, that’s good for me! Just do it.”.

然后，提醒我一次，不要试图强迫我做些事情。所有这些提醒！我不断受到欺负。如果我的保险和医生可以从我的盘子上取下东西，这对我有好处！只要这样做。”。

Seventy-seven percent of patients said in a recent poll that they want their healthcare professional to prescribe the cheapest drug automatically (77.6%). Further, when asked if they would have a more favorable opinion of their health plan if it offered a lower-cost drug benefit, more than 80% said “Yes.”.

百分之七十七的患者在最近的一项民意调查中表示，他们希望他们的医疗保健专业人员自动开出最便宜的药物（77.6%）。此外，当被问及如果提供更低的药物时，他们是否会对自己的健康计划持更有利的意见成本效益，超过80%的人表示“是”。

Employees stress about how much health information they receive, and the number of health decisions placed upon them. The American Academy of Physician Associates (AAPA) poll identified a major pitfall in patient experience: care coordination feels like a second job for many.

员工强调他们收到多少健康信息，以及对他们做出的健康决定的数量。美国医师协会（AAPA）的民意调查发现患者体验存在重大缺陷：护理协调对许多人来说就像第二份工作。

Despite this sentiment, technology in healthcare continues to overwhelm and overload consumers. Instead of making it easier to get and stay healthy, they must learn medicine and play doctor. But if the burden is to fall on the physicians, they need tools and tactics that integrate into their standard workflow..

尽管有这种情绪，医疗保健领域的技术继续压倒和超载消费者。他们必须学习药物，玩医生，而不是让自己更容易获得和保持健康。但是如果负担落在医生身上，他们需要整合到他们标准工作流程中的工具和策略。。

Physician experience: Dr. Mohan on the difficulty of prescribing the lowest cost medication.

医生经验：Mohan博士关于处方成本最低的药物的难度。

“I see this daily. A patient will call, very upset, after going to the pharmacy and hearing how much the medication will cost. We do the research in our clinic to prescribe the lowest-cost option, but every person’s formulary is different. The pharmacy they go to matters. There are a lot of variables.

“我每天都会看到这一点，患者去药房后会非常不安地听到药物的费用。我们在诊所进行研究，规定最低成本的选择，但每个人的处方都不同。他们去关注的药房。有很多变量。

We get on the phone with the pharmacy to test out the cost of each option. It’s slow going. Health insurers also offer apps and websites, but this often adds confusion to the process. There is a better way to prescribe than trial and error.”.

我们打电话给药房测试每种方案的成本。进展缓慢。健康保险公司也提供应用程序和网站，但这往往会增加这个过程的混乱。开处方的方法比反复试验更好。”。

Using HealthTech to Manage Pharmacy Costs

使用HealthTech管理药房成本

To solve wasteful prescribing problems, self-funded companies are turning to AI-driven solutions that engage prescribers directly, giving them the information and the choice to effortlessly switch their patients off higher-priced prescriptions and onto more affordable therapeutic equivalents.

为了解决浪费的处方问题，自资公司正在转向AI驱动的解决方案，直接与处方者互动，为他们提供信息和选择，毫不费力地将患者从价格较高的处方转换为更实惠的治疗方案。

The engagement process for employees is important to ensure they understand that the savings lower their out-of-pocket pharmacy costs. Prescribers are then engaged and recruited as partners to help lower drug costs for their patients instead of playing a guessing game about what drugs are covered for their patients..

员工的参与过程对于确保他们了解节省的费用可以降低他们的自付药费非常重要。然后，处方者作为合作伙伴参与并招募，以帮助降低患者的药物成本，而不是猜测患者所涵盖的药物。。

When a prescriber-driven switch is approved, the employee is notified that their physician prescribed a lower-cost medication. Employees have the option to accept or reject the medication change though less than 1% opt out of the change. Data shows that employees working directly with their physician on medication choices have higher adoption rates than those using a 3rd party app.  .

当处方驱动的开关被批准时，通知员工他们的医生开出较低成本的药物。员工可以选择接受或拒绝药物变更，但只有不到1%的人选择退出变更。数据显示，与使用第三方应用程序的员工相比，直接与医生合作选择药物的员工采用率更高。  .

With excellent communication and frictionless engagement, employees readily see the value and appreciate the savings. Employers take control of the biggest threat to employer-provided medical coverage: high-cost pharmacy claims. Using technology to solve intractable problems is the best way to stabilize pharmacy budgets..

凭借出色的沟通和无摩擦参与，员工可以轻松查看价值并欣赏节省的费用。雇主控制对雇主提供的医疗保险的最大威胁：高成本的药房索赔。使用技术解决棘手问题是稳定药房预算的最佳方法。。

About Constance SjoquistConstance Sjoquist is a Senior Healthcare Analyst at RazorMetrics. Prior to joining RazorMetrics, Constance was Chief Transformation Officer at HLTH, where she helped create from the ground floor the largest and most important conference for health innovation. As one of the primary architects in shaping the voice and creating the agenda for a new conversation on how to improve health, Constance leveraged her cross-industry insights into a robust platform for market disruption and industry transformation.

关于Constance SjoquistConstance Sjoquist是RazorMetrics的高级医疗分析师。在加入RazorMetrics之前，Constance是HLTH的首席转型官，她帮助从一楼创建了最大，最重要的健康创新会议。作为塑造声音和制定关于如何改善健康的新对话议程的主要建筑师之一，Constance将她的跨行业见解利用为市场破坏和行业转型的强大平台。

During her tenure, HLTH grew from just a concept to one of the leading industry events with over 7,500 senior leaders spanning every corner of health – payers, providers, pharma, employers, policy-makers, investors, startups, suppliers, retailers, analysts, and associations – and focused on creating the future of health..

在任职期间，HLTH从一个概念发展到一个领先的行业活动，拥有超过7500名资深领导者，跨越健康的各个角落-付款人，提供商，制药公司，雇主，政策制定者，投资者，创业公司，供应商，零售商，分析师，和协会-并专注于创造健康的未来。。