prescription drugs – Workforce

The escalating cost of prescriptions is a hard pill to swallow for employees. That’s because it’s becoming more common for prescription drug plans to shift the cost to participants. Then there’s the behind-the-scenes double Rx whammy: pharmaceutical companies increase prices and pharmacy benefit managers obscure the true cost of medications, causing more headaches for employees.

Employees also feel blindsided when the PBM adjusts its formulary or the plan sponsor moves participants to a high-deductible health plan. Rx sticker shock is on the rise. Consider the employee whose monthly copay of $20 for a generic drug skyrockets to 10 times that per month under an HDHP.

Employees have a hard time paying for important maintenance medications. As prices keep rising, patients are less likely to fill new prescriptions or continue taking maintenance drugs, which can cause more health issues and cost medical plans even more down the road.

Unfortunately, many employees don’t know that the pharmacy they frequent may not always offer the lowest price for their medications. There are more options for finding low-cost prescription drugs than there were even five years ago, but it doesn’t necessarily follow that employees know they actually can price-shop prescriptions.

Also read: What to Ask Your Pharmacy Benefit Manager to Control Spike in Prescription Spending

Employers can work with their insurance brokers to educate employees about better ways to find reasonably priced prescription medications.

In the meantime, here are three Rx buying tips you can share today with your employees.

Retail Store Discounts

Some large retail stores, including Target, Walmart and many grocery store chains, offer discounts on popular brand name and generic medications at low or no cost without insurance simply to drive traffic to their stores. These loss leaders attract shoppers who are likely to buy a few items when they pick up their medication at the in-store pharmacy. The prices of brand name and generic drugs that are discounted vary from store to store. It pays for employees to investigate where they can get the best deal for their medications.

ShopRite, a grocery store chain in the Northeastern United States, has been dispensing free diabetes medications since 2009. Similarly, grocery chain Publix offers the generic type 2 diabetes drug metformin at no cost. The grocery chain also offers 14-day supplies of several prescribed antibiotics at no cost. Walmart offers several drugs at $4 for a 30-day supply and $10 for a 90-day supply. The key to this strategy is to keep “impulse purchases” to a minimum.

Mobile Apps

Not surprisingly, the web now makes it easier to track down the cheapest generic prescription medications. Two examples are GoodRx and Blink Health, which both provide medication prices and direct customers on buying options.

GoodRx collects drug prices from thousands of pharmacies to show where a specific medication can be purchased at the lowest price. They also aggregate coupons and discount programs from manufacturers. Blink Health partners directly with drug manufacturers and negotiates lower prices for medications. Blink Health conveniently lets consumers pick up medications at a pharmacy or order them by mail. Importantly, coupons on these sites often make the price of a medication lower than the copay through the prescription plan.

Manufacturer’s Coupons

Prescription drug manufacturers often offer discounts and coupons for their drugs. If a medication costs more than $50, for example, the manufacturer may cover part of the balance. To access a coupon, just contact the manufacturer to enroll in the savings card program.

Some manufacturers will cover the balance of the drug cost and contribute the balance toward the employee’s deductible. After just a month or two of a higher-priced prescription drug and a manufacturer’s discount, an employee may satisfy their deductible and pay only the copays for the rest of the plan year.

Educating employees about free and discounted drugs starts during open enrollment, but it shouldn’t end there. Emails, postcards and announcements from the HR team are good reminders for employees. Some HR departments develop targeted communications that list expensive prescription drugs and how to save. Helping employees learn how to shop for the best prescription prices can help to keep them healthy and help you contain costs.

Also read: Contracting a Cure for Prescription Drug Costs

Can an employer include prescription medications in its drug screening of job applicants and employees? Here’s a good lawyer answer for you: It depends.

Last week, the EEOC announced that it had sued an Arizona car dealership for disability discrimination after it rescinded a job offer when a pre-employment drug test revealed a prescription drug used to treat a disability.

According to EEOC’s lawsuit, Bell-Arrow Automotive, Inc. (doing business as Bell Lexus), a subsidiary of Bell Leasing, Inc. (doing business as The Berge Group), maintained a policy of refusing to employ any applicant who tested positive for one of several enumerated substances on a list identified by Bell Lexus and the Berge Group. Bell Lexus extended a job offer to Sara Thorholm to work as product specialist or a salesperson, but rescinded it when her drug test returned positive for a single substance. Thorholm explained to Bell Lexus that the substance was legally prescribed to treat a disability and would not affect her ability to perform the duties of the job. Bell Lexus refused both Thorholm’s offer of proof and her offer to change medications.

The EEOC contends that the employer violated the ADA by maintaining a “blanket exclusion policy” for certain prescription medications, and refusing to consider an exception to its drug testing policy as a reasonable accommodation. Indeed, according to the EEOC’s Enforcement Guidance on Disability-Related Inquiries and Medical Examinations of Employees Under the ADA, in most cases an employer cannot even ask about prescription drugs:

Asking all employees about their use of prescription medications is not job-related and consistent with business necessity. In limited circumstances, however, certain employers may be able to demonstrate that it is job-related and consistent with business necessity to require employees in positions affecting public safety to report when they are taking medication that may affect their ability to perform essential functions. Under these limited circumstances, an employer must be able to demonstrate that an employee’s inability or impaired ability to perform essential functions will result in a direct threat. For example, a police department could require armed officers to report when they are taking medications that may affect their ability to use a firearm or to perform other essential functions of their job. Similarly, an airline could require its pilots to report when they are taking any medications that may impair their ability to fly. A fire department, however, could not require fire department employees who perform only administrative duties to report their use of medications because it is unlikely that it could show that these employees would pose a direct threat as a result of their inability or impaired ability to perform their essential job functions.

In other words, it is the rare case in which an employer is justified in asking about prescription meds, or disqualifying from employment one who tests positive.

How is an employer supposed to to maintain a safe workplace in light of these limitations? Here are four thoughts.

Blanket prohibitions are illegal. The ADA imposes on employer an obligation to make individualized inquiries about implications such as reasonable accommodations and direct threats. A blanket prohibition against on-the-job use of prescriptions medications violates this obligation.
Drug testing. Drug testing programs can include legally prescribed drugs. An employer cannot, however, have a blanket policy excluding from employment any employee testing positive for a prescribed drug. Instead, following a positive test, the employer should ask if the employee is taking any prescribed drugs that would explain the positive result.
Drug-free workplace policies. It is permissible to include prescription drugs in drug-free workplace policies. These policies can require employees to disclose prescription drugs that may adversely affect judgment, coordination, or the ability to perform job duties. After disclosure, an employer must, on a case-by-case basis determine whether it can make a reasonable accommodation that will enable the individual to remain employed.
Post-disclosure handling. After an employer learns that an employee is taking a prescription drug that may affect job performance, it should request a medical certification regarding the effect of the medication on the ability safely to perform essential job functions. That certification will enable the employer to engage the employee in the interactive process and making the individualized determination of whether a reasonable accommodation is even possible.

“What about medical marijuana,” you ask? How do these ADA concerns impact its impending legality? I’ll have more to say about this in a future post, but, most of the courts that have examined the issue of workplace drug testing for states in which medical marijuana is legal have concluded that the ADA does not protect medical marijuana because the drug remains illegal under federal law.

Stay tuned, however, as the issue of medical marijuana under the ADA is nuanced and certainly developing and subject to change.

Jon Hyman is a partner at Meyers, Roman, Friedberg & Lewis in Cleveland. Comment below or email editors@workforce.com. Follow Hyman’s blog at Workforce.com/PracticalEmployer.

Tag: prescription drugs

3 Ways to Help Employees Save Money on Prescriptions

The ADA and Prescription Meds: What You Need to Know