More and more employers are making the shift toward consumer-driven health care, and it’s not hard to see why. It’s far less expensive for the employer and, depending on their overall health and lifestyle, often less expensive for employees as well. However, there are still some issues associated with consumer-driven health care that need to be explored. Among them, how can your pharmacy accommodate a patient on one of these plans?
Consumer-Driven Health Care Explained
When people discuss consumer-driven health care, they’re usually referring to high-deductible health plans, often complemented by a tax-advantaged HSA or FSA account for medical expenses. These health plans generally mean lower premiums for the employer as well as more financial control (and often more take-home pay) for employees. However, consumer-driven health plans do have a reputation of causing people to not seek treatment when they should in the interest of saving money.
Preventative care is the exception, often covered by plans even before a patient has met their deductible. In 2019, the IRS redefined what type of care constituted “preventative care” and was therefore covered by even high-deductible health plans:
- Periodic health evaluations like annual physicals, including tests and diagnostic procedures
- Routine prenatal and well-child care
- Immunizations for children and adults
- Smoking-cessation programs
- Weight-loss programs
- Various screening services, such as mammograms or glaucoma screenings
So what can your pharmacy do to accommodate patients with consumer-driven health plans?
Be Flexible in Dispensing Amounts
Adherence is the name of the game. If your patient would save money with a 90-day supply instead of a 30-day supply (and you can dispense enough for 90 days), that’s what you should do. Medication non-adherence impacts patient health outcomes, and high prescription costs directly contribute to non-adherence. You can mitigate that factor by offering options beyond the standard 30-day refill.
Likewise, if a patient is trying a new medication, it might be better to fill a smaller amount, then monitor the results. If the treatment is working as expected, the physician can prescribe medication to cover a longer period. If it isn’t, the patient didn’t have to pay for a full 30-day supply.
Suggest Discount Programs to Save Them Money on Prescriptions
High-deductible health plans don’t cover prescriptions. These patients pay for their medications either completely out of pocket or with an HSA or FSA. Since they don’t have a prescription copay, the cost of their medications can run anywhere from reasonable to ridiculous. One way to help these patients is through discount programs. We know they can often be a headache for pharmacists, but discount coupon programs or even solutions like GoodRx can improve adherence by keeping patients from falling off their medication plans.
Make Sure Your HDHP Patients Are Vaccinated
Yes, we know you can’t force your patients to get vaccinated. However, you can explain the health benefits of getting vaccinated against diseases that could keep them out of work. “Get your flu shot,” says Elizabeth Abbott, director of California’s Office of the Patient Advocate, in an article for Kaiser Health News. “If you keep up with all of your preventive services, you will save yourselves a fair amount of money because you’re less likely to get sick.”
Plus, consumer-driven health care plans consider immunizations preventative care. Even patients who haven’t met their deductible can still get their flu shots, and their plan will cover it. By promoting immunizations to your HDHP patients, you’re keeping them healthy while also improving profitability in your pharmacy. It’s a win-win.
Consumer-driven health care plans are different from other employer health plans or government plans. Patients are in the driver’s seat. But that doesn’t mean their care is compromised. By keeping just a few things in mind, you can ensure that HDHP patients receive the same excellent patient care as your other insurance patients.