Of all of the components that drive up well being care prices, spending on prescribed drugs is without doubt one of the most vital.

That’s the reason it’s excessive on the agenda of many self-confident employers and the employment circumstances advisors who information them of their decision-making.

Three in 5 consultants, or 61%, stated they may spend extra time advising purchasers on prescription drug prices this yr, in keeping with findings from the 2024 Profit Guide Sentiment Index. To obtain the report, click on right here.

The Index, now in its second yr, is predicated on a survey of greater than 100 seasoned well being advantages consultants who present steerage to a cross-section of employer sizes. Revealed by MedCity Information and sponsored by Quantum Well being, the Index has turn into a “reference” barometer for consultants within the business.

The examine highlights a number of the adjustments in the way in which medical insurance advisors are advising self-insured employers. Along with suggestions round prescription spending, the examine additionally tracked altering attitudes in regards to the position of synthetic intelligence, rising curiosity in GLP-1 medicine like Ozempic and Wegovy, navigation, and fatigue over the amount of area of interest options obtainable to employers.

Spending on medicines is rising, largely as a result of elevated use of GLP-1s, medicine initially developed for individuals with diabetes which have confirmed comparatively efficient in lowering weight. However regardless of the medicine’ recognition, fewer than one in three advisors, or 31 %, suggest complete protection. Almost half, or 47 %, suggest each will increase and reduces in protection, relying on the shopper.

Paul Fronstin, director of well being advantages analysis on the Worker Profit Analysis Institute (EBRI), spoke in a phone interview in regards to the complicated questions the drug raises for employers.

“It's nonetheless a model new drug and employers are going to have to determine easy methods to transfer ahead,” Fronstin stated. For instance, employers might need to impose circumstances earlier than approving protection for plan members who use the medicine for weight reduction.

Employers additionally need to see what different employers are doing in regards to the fashionable medicines. “Most traits take off like an airplane, not an area shuttle,” Fronstin stated. “It may well take years to stand up to cruising altitude with a few of these.”

Harrison Newman, vp of Company Synergies, stated in a phone interview that GLP-1 medicine are producing quite a lot of curiosity amongst employers. Nevertheless, he admitted that he solely states the professionals and cons of the medicine, quite than recommending one aspect or the opposite. This permits employers to make well-considered decisions.

“There are two elements to the choice of corporations to supply GLP-1 medicine. One facet is monetary, the opposite is cultural. Are you a company in a aggressive house the place if you happen to don’t provide this, individuals will exit and get it and it’ll have an effect on the tradition of the group? There’s additionally a monetary viewpoint,” Newman stated. “These are costly medicine. What are the long-term advantages of individuals taking these medicine? Will it result in a lower in weight problems? A trickle in [Type 2] diabetes results in a lower in healthcare prices? We have now seen corporations undertake the strategy of providing [GLP-1 drugs] however others say it's not a long-term answer, particularly if individuals regain the load or can't take care of the unwanted side effects of the treatment. However even corporations that supply it [in their healthcare benefits] don't promote it.”

In the case of one other development – the combination of synthetic intelligence into healthcare – advantages consultants are advising their purchasers in quite a lot of areas, in keeping with The Index. The commonest are: facilitating personalised determination help to assist workers make higher selections about advantages (50%); lowering administrative burdens (49%); and predictive analytics for price optimization and sickness administration (43%).

“The adoption of AI mixed with the usage of different applied sciences corresponding to cloud computing, knowledge modernization and analytics, and the Web of Issues can’t solely consolidate healthcare processes and affected person knowledge, but additionally remodel the strategy to affected person care, making it extra personalised, accessible and environment friendly,” stated Tina Wheeler, vice chair and healthcare sector chief at skilled companies agency Deloitte LLP, in response to emailed questions.

Generative AI particularly might assist deal with challenges corresponding to labor shortages and burnouts, Wheeler stated. The expertise already performs a task in billing, cost, prior authorization, fraud detection and different areas.

“Curiosity and adoption have grown so rapidly that it's solely a matter of time earlier than it turns into way more pervasive all through the business,” Wheeler stated. “We’re already seeing organizations establishing new organizational buildings and roles, together with Chief AI Officers.”

AI can be popping up within the numerous schemes for self-insured employers, making it much more troublesome for them to select from completely different choices.

Employers have already been working to restrict the options they provide their workers, Fronstin stated. “Extra level options with AI simply make it extra sophisticated.”

The truth is, 84% of consultants say their purchasers are experiencing “level answer fatigue,” in keeping with The Index. And almost two in three consultants, or 63%, say their purchasers need to consolidate options below a single healthcare navigation answer.

Almost half of respondents, 46%, say their purchasers are contemplating consolidation by an unbiased supplier, making it the only option, in keeping with The Index. Insurer navigators arrived at 38%.

Seeing unbiased navigators on the prime got here as a “nice shock” for Wheeler.

“We're not seeing explosive progress in these corporations and their market penetration currently, however we might see this point-solution fatigue turning into a tipping level for them,” Wheeler stated. “The shoppers who use these navigation platforms typically like them quite a bit.”

One space the place navigation instruments come into play is most cancers care. Based on The Index, 41% of consultants see healthcare navigation instruments and companies as a finest observe for employers trying to help workers with the illness. Different finest practices embody screening for early detection (67%); flexibility of employers round work (49%): most cancers facilities of excellence (47%); and behavioral well being counseling (43%).

The rising curiosity in preventive care can be a hanging discovering of the examine. For the primary time, the realm is receiving extra consideration than power situation administration, which was recognized as the most typical suggestion by 39% of consultants this yr. Final yr, power situation administration was really helpful by 46%, with preventive care at 29%.

Based on the Index, greater than two in 5 counselors (42%) most frequently suggest preventive care applications to purchasers involved about price management.

“By focusing extra on well being upkeep and illness prevention, we will attempt to scale back the incidence and severity of those illnesses, thereby reducing well being care prices,” Wheeler stated. “This shift to preventive care is a proactive technique that improves high quality of life and sustainability within the healthcare system, and necessitates collaboration amongst suppliers, insurers and policymakers.”

Prevention is sweet, Fronstin stated. Nevertheless, it seemingly impacts future prices greater than present prices, 80% of which usually comes from 20% of an employer's inhabitants.

“Should you don't give attention to them, it doesn't actually matter what else you do,” he stated.

To obtain the Sentiment index of profit consultants 2024 report, please full the shape: