Boosting Health and Savings: Employee Engagement in Pharmacy Benefits

Boosting Health and Savings: Employee Engagement in Pharmacy Benefits

Employee engagement is a concept that transcends being just a buzzword; it is a strategic imperative that carries profound significance for self-funded employers and pharmacy benefit manager (PBM) consultants. Engaging employees in their healthcare is an integral part of fostering a culture of health and well-being within organizations. It goes beyond mere participation; it entails empowering individuals to actively manage their health, make informed decisions, and take charge of their healthcare journey. This level of engagement holds transformative potential, particularly when applied to pharmacy benefits, and can yield a multitude of favorable outcomes. Let’s explore the role that employee engagement in pharmacy benefits plays in optimizing health outcomes and savings. 

1. Improved Medication Adherence: A Cornerstone of Health

Among the many compelling benefits of employee engagement in pharmacy benefits, one of the most impactful is the significant enhancement of medication adherence. Medication adherence is often considered the cornerstone of effective disease management. It refers to the extent to which patients take their prescribed medications as directed by healthcare professionals. This aspect of healthcare engagement is a pivotal factor in determining an individual’s health outcomes and overall well-being.

When employees become active participants in their healthcare decisions, they are far more likely to adhere to their prescribed medication regimens. This is not merely a matter of compliance but is closely tied to a patient’s understanding of their health condition and the role that medications play in managing it. Engaged employees invest time and effort in learning about their conditions, medications, and potential side effects, which empowers them to make informed decisions regarding their health.

Non-adherence to medications can have far-reaching and detrimental consequences. It can lead to uncontrolled chronic conditions, causing disease progression and necessitating more extensive and costly medical interventions in the long run. The financial implications of non-adherence are substantial, as it leads to increased healthcare costs for both employees and employers.

Enhanced medication adherence, fueled by employee engagement, can generate a ripple effect of positive health outcomes. When individuals consistently take their medications as prescribed, chronic conditions can be better managed, reducing the risk of complications and hospitalizations. This translates into not only improved health for employees but also substantial cost savings for self-funded employers.

2. Informed Decision-Making: The Path to Efficient Healthcare

Engaged employees are better equipped to make well-informed decisions about their medications. This empowerment is born out of their proactive approach to managing their health. They become avid researchers, exploring various treatment options, consulting healthcare providers, and weighing the pros and cons of different medications.

This proactive stance extends to understanding the financial implications of their healthcare choices. Engaged employees are more likely to take a cost-effective yet clinically appropriate approach to their treatments. They actively seek out information on medication formularies, pricing, and potential discounts or assistance programs.

The benefits of informed decision-making radiate outward, affecting both individual employees and their employers. On a personal level, it ensures that employees are not only receiving appropriate care but are also actively participating in reducing their own healthcare costs. For employers, this contributes to cost containment by mitigating unnecessary healthcare expenditures and ensuring that resources are allocated more efficiently.

By making informed decisions, employees are not merely passive recipients of healthcare; they become proactive partners in their own well-being. This level of engagement results in a win-win situation, where employees receive cost-effective, quality healthcare, and employers see a reduction in healthcare expenses.

3. Preventive Care: The Shield Against Future Ailments

Proactive engagement in pharmacy benefits extends beyond the realm of medication management. It encompasses the broader sphere of preventive care. Engaged employees are more likely to take full advantage of preventive services, such as vaccinations and screenings.

Preventive care plays a crucial role in healthcare by detecting health issues at their earliest stages, often before symptoms manifest. This early detection enables timely intervention, potentially reducing the severity of illnesses and, consequently, the need for more costly treatments down the road. In this context, employee engagement is the driving force behind maintaining good health and minimizing future healthcare expenses.

When employees actively engage in their pharmacy benefits and the broader healthcare system, they are more likely to participate in routine check-ups and screenings. This vigilance allows for the early identification of conditions such as hypertension, diabetes, and certain cancers. Early detection can lead to timely intervention and effective management, all of which contribute to better health outcomes.

Additionally, preventive care extends to vaccinations, which are essential for protecting against contagious diseases. Engaged employees are more likely to stay up to date with their immunizations, reducing the risk of widespread outbreaks within the workplace and community. This level of engagement and preventive action ultimately benefits the well-being of the entire workforce.

Typical Employee and/or Plan Changes: Pros and Cons

As we explore ways to enhance employee engagement in pharmacy benefit programs, they often consider various plan changes. These changes can have both positive and negative impacts on different employees. Let’s explore some typical plan adjustments and their associated pros and cons.

Employees Considering High-Deductible Health Plans (HDHPs)

Pros: HDHPs can be a cost-effective option for self-funded employers. They typically come with lower premiums, encouraging employees to take a more active role in their healthcare spending. This can lead to cost savings for both employers and employees.

Cons: On the flip side, HDHPs may deter some employees from seeking necessary care due to the higher out-of-pocket costs. Employees with chronic conditions or frequent prescription needs might find it challenging to manage their healthcare expenses under an HDHP. 

Formulary and Copay Changes

Pros: Adjusting a formulary and copay amounts can encourage employees to opt for cost-effective medications. By offering lower copayments or coinsurance for generic drugs, employees can be incentivized to choose more affordable alternatives.

Cons: Employees on specific brand-name medications may face increased out-of-pocket costs if the medication is no longer preferred, potentially leading to non-adherence or financial strain. It’s crucial to ensure that this change is carefully communicated, and options for financial assistance are made available for affected employees.

Pharmacy Networks

Pros: Limited or preferred pharmacy networks can offer significant savings for self-funded employers by steering employees to select pharmacies that provide medications at a lower cost. This can be particularly advantageous for those employees with complex medical conditions.

Cons: On the downside, employees may experience inconvenience if their current pharmacy is  not considered a preferred pharmacy or is no longer within the pharmacy network. It’s essential to offer clear guidance and support to employees navigating this change.

The Role of Local Community Pharmacies

While plan changes can be a valuable tool for optimizing pharmacy benefits, it’s equally essential to recognize the vital role that local community pharmacies play in the healthcare ecosystem. Community pharmacies are often the most accessible healthcare providers for many employees. By fostering partnerships with these local establishments, self-funded employers can enhance employee engagement, adherence, and overall health outcomes.

Accessibility and Convenience

Local community pharmacies are often located close to where employees live and work. This accessibility makes it easier for employees to fill their prescriptions promptly, promoting medication adherence.

Personalized Care

Community pharmacists provide personalized care, offering valuable guidance and information about medications. This personal touch can enhance employee understanding and engagement in their healthcare.

Building Trust

Over time, employees build trust with their local community pharmacists, which can lead to better communication and adherence. This trust is particularly vital for employees managing chronic conditions.

MaxCare and Community Pharmacies

At MaxCare, we understand the importance of local community pharmacies in the healthcare journey. We’re committed to supporting these essential healthcare providers and integrating them into our pharmacy benefit programs. Our network includes a wide range of community pharmacies, as well as nationally recognized chains, ensuring that employees have the flexibility to choose where they receive their care.

By maintaining strong partnerships with local community pharmacies, we empower employees to access care that is both convenient and personalized. MaxCare’s commitment to community pharmacies aligns with our dedication to promoting employee engagement, medication adherence, and ultimately, better health outcomes.

In conclusion, the power of employee engagement in healthcare, especially in the context of pharmacy benefits, cannot be overstated. Engaged employees actively participate in their healthcare decisions, leading to improved medication adherence, informed decision-making, and a commitment to preventive care. These elements collectively result in better health outcomes, cost savings, and a thriving culture of well-being within organizations. For self-funded employers and PBM consultants, recognizing and harnessing the potential of employee engagement in pharmacy benefits is a strategic imperative that can yield lasting benefits for both employees and their organizations.

While plan changes can offer various advantages, it’s essential to carefully consider their potential impact on different employees. And, let’s not forget the invaluable role of local community pharmacies in fostering employee engagement, trust, and adherence. MaxCare stands by community pharmacies as a cornerstone of our commitment to employee health and well-being.

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