The Rising Tide of Pharmacy Benefit Cost and Complexity:

A health plans roadmap to optimizing pharmacy services relationships

The pharmacy landscape is rapidly changing, causing health plans and other payers to rethink their pharmacy strategy. Deloitte has developed a roadmap for plans to address the increasing cost, complexity, and market demands.

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Uncertain times

After several years of manageable pharmacy cost increases, health plans face an uncertain future, evidenced by headlines about increasing utilization, costly specialty medications, and higher regulatory and consumer expectations.

Without taking action, pharmacy benefits will squeeze health plan margins further. Future success demands a renewed focus on all elements of pharmacy cost and a strategy to embrace new challenges.

The approach

As health plans rethink their approach to pharmacy, they should think about three categories of focus:

  1. Core program components that are primarily cost-based, such as trend review and plan design;
  2. Evolving program components that are rising in importance due to health reform and changing market dynamics; and
  3. Innovative opportunities that envision a future of highly integrated and consumer-centric care.  

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