CancerCare® Releases Employer Guide to Prescription Drug Benefit Design for Employees with Serious Illness

Toolkit offers guidance on how employers can provide high quality, cost effective pharmacy benefits, while avoiding undue financial burden on employees

CancerCare today released “The Employers’ Prescription for Employee Protection Toolkit: Best Practices for Prescription Drug Benefit Design,” to help benefits managers, human resources professionals, and executives better understand and navigate the unintended consequences of utilization management (UM).

UM, which helps health insurance providers contain costs, weed out unproven treatments, and evaluate physicians’ treatment recommendations, can negatively impact patient outcomes, especially for those with serious or chronic illnesses. Administrative snarls, delays, stress and costly out-of-pocket expenses for people diagnosed with life-threatening conditions are among the frequent challenges presented by UM, such as medication non-adherence, which is estimated to cost the economy between $100 million and $290 million annually.

“Many cost-saving practices seem benign but can cause great harm, particularly to those with serious or chronic health conditions,” said Patricia J. Goldsmith, Chief Executive Officer, CancerCare. “Insurance plan restrictions often prevent patients from accessing the medications they desperately need, which in turn, can have a critical impact on employee wellbeing and productivity.” She points to data showing that patients experience, on average, a 31 day delay in accessing medication that is subject to pre-authorization.

CancerCare’s new educational resource explores the burdens and obstacles of common UM practices and offers recommendations to help employers and benefits managers create a strong, patient-focused prescription coverage plan that can reduce long term costs and contribute to higher employee productivity and satisfaction. The toolkit includes a comprehensive explanation of how UM can impact access to pharmacy benefits, and includes illustrated fact sheets about common UM practices and their potential impacts. It also includes a video series featuring real patients describing the day-to-day consequences of their insurance plan’s UM policies.

“The high costs of healthcare represent a significant burden and source of stress on U.S. families,” said Ellen Miller-Sonet, Senior VP, Chief Strategy & Policy Officer, CancerCare. “The goal of employer-provided health coverage is providing access to swift and effective treatment, to resolve symptoms and avoid poor outcomes. We created this comprehensive educational resource to explain UM practices and suggest ways to implement these policies to address real utilization issues while not creating roadblocks to necessary treatments.”

The toolkit is available free for employers and the public, and can be accessed here.

About CancerCare®
Founded in 1944, CancerCare is the leading national organization providing free, professional support services and information to help people manage the emotional, practical and financial challenges of cancer. Our comprehensive services include case management, counseling and support groups over the phone, online and in-person, educational workshops, publications and financial and co-payment assistance. All CancerCare services are provided by master’s-prepared oncology social workers and world-leading cancer experts.

About The Employers’ Prescription for Employee Protection Toolkit
The Toolkit helps inform the benefits package design and decision-making process and offers key considerations when looking at plans that include utilization management. Providing best practice recommendations to help employers evaluate health plan options, the Toolkit includes sections on pre-authorization, formulary design, step therapy, specialty pharmacies, copay accumulator programs, the appeals process and financial non-adherence.

Editor’s Note
Interviews are available with:
Patricia Goldsmith (PA & NY) on prescription drug benefit design/formulary design
Amy W. (DC) on pre-authorization
Jen (Utah) on co-pay accumulators

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