Manage HR Magazine | Saturday, January 20, 2024
Patients in the US have borne a disproportionate share of growing healthcare expenses, with PBMs and insurance companies leading the cost-shifting movement. Unfortunately, the shift toward high-deductible health insurance has only worsened the situation, significantly increasing medical debt.
Fremont, CA: Businesses that value their employees' health and productivity recognize the importance of giving them access to high-quality healthcare. However, cancer, the second leading cause of mortality in the US, accounts for 12 percent of employers' medical expenses, and its treatment is four times more expensive than other serious illnesses like diabetes or stroke. Despite the importance of cancer care, some obstacles may prevent workers from getting the necessary medical attention they need.
Stay ahead of the industry with exclusive feature stories on the top companies, expert insights and the latest news delivered straight to your inbox. Subscribe today.
Companies must identify and eliminate these obstacles to ensure that their employees have access to the best cancer treatment. They should offer comprehensive health insurance policies covering all aspects of cancer care and enabling employees to get cancer testing, evaluation, treatment, and follow-up care easily.
Utilization management (UM): UM is a cost-saving measure in many insurance plans. Still, it can make it difficult to get timely testing, proper treatments, and access to cutting-edge medications that are most effective in treating or curing cancer. While UM can help control a payer's short-term expenses, it may have unforeseen effects that hinder prompt diagnostic and treatment availability.
Biomarker testing: It is the most important development in cancer treatment. It identifies the genetic alterations that cause a person's illness and helps medical professionals customize treatment for each patient's malignancy. Biomarker testing can identify targeted medicines that can control lung, breast, colorectal, and melanoma cancers, along with some uncommon cancers. Additionally, biomarker testing prevents potentially ineffective generic techniques and helps identify clinical trial prospects.
However, even though biomarker testing has improved patient outcomes and saved healthcare costs, many employee health insurance plans do not fully cover the recommended care based on guidelines. Drug company rebates often influence which prescription drugs are included in the formulary and at what price point, which may affect cancer patients since some medications may be removed from the formulary, leaving them with no other option but to accept therapies that may not be the best fit for their unique requirements or may have unfavorable side effects. Policies that limit medication coverage to only those selected by PBMs may prevent cancer patients from accessing life-saving medicines, given the surge in customized cancer treatments.
Cost: Patients in the US have borne a disproportionate share of growing healthcare expenses, with PBMs and insurance companies leading the cost-shifting movement. Unfortunately, the shift toward high-deductible health insurance has only worsened the situation, significantly increasing medical debt. Companies must ensure that their employees have access to high-quality healthcare and reduce the escalating costs of healthcare benefits. Understanding that some seemingly cost-cutting measures may not provide employees with enough patient-centered coverage is essential.
More in News