Report of Research on Pharmacy Benefit Managers’ Prior Authorization Denial Rates for Specialty Drug Prescriptions
We conducted research on prior authorization, one of the most frequently used utilization-management programs for prescription drugs. We focused on 10 therapeutic drug classes that have specialty drugs.
The information we gathered from pharmacy benefit managers (PBMs) suggests there are no industry standards for prior authorization denials. Consequently, potential savings from prior authorization may depend on which PBM a plan sponsor uses.
Salary Budget Increases: Flat for the Fourth Straight Year
Sibson Consulting’s Annual Compensation Planning Analysis indicates that salary budget increases for 2018 will remain consistent with the past four years, with 3.0 increases projected for executive, exempt and non-exempt jobs.
2018 Segal Health Plan Cost Trend Survey
Health plan cost increases continue to outpace general inflation and average wage increases, underscoring the need to monitor performance targeting cost-management efforts. Plan sponsors can use the 2018 Segal Health Plan Cost Trend Survey results to support their 2018 rate renewal negotiations and their budget projections.
Salary Budget Increases Remain Flat … Again
Sibson Consulting's latest Compensation Planning Analysis indicates that salary budget increases for 2017 will remain consistent with the past three years.
College and University Benefits Study (CUBS) Infographic: Tuition and Non-Traditional Benefits
Many institutions are using tuition and non-traditional benefits to improve their recruitment success. This infographic notes developments and statistics in these benefit offerings, including how free tuition offerings are changing.
2017 Segal Health Plan Cost Trend Survey Infographic
Prescription drug benefit cost trends for active populations continue to increase at double-digit rates, with an exceptionally large trend increase in specialty and biotech drugs.
College and University Benefits Study (CUBS) Infographic: Changes in Defined Contribution Plans for Higher Ed Employees
This infographic notes developments and statistics in employee defined contribution plans, including how many institutions are offering matching contributions and the median percentage of contribution rate.
2017 Segal Health Plan Cost Trend Survey
Health benefit plan cost trend rates for 2017 are projected to be similar to prior levels for most medical plan options. However, carved-out prescription drug benefit cost trends for active populations continue to increase at double-digit rates, according to forecasts compiled in the 2017 Segal Health Plan Cost Trend Survey, Segal Consulting’s 20th annual survey of managed care organizations, health insurers, pharmacy benefit managers and third-party administrators. Trend Survey, the 20th annual survey of managed care organizations (MCOs), health insurers, pharmacy benefit managers (PBMs) and third-party administrators (TPAs) conducted by The Segal Group of which Sibson Consulting is a member.
Here are some of the key findings from the survey and our observations about actions plan sponsor may want to take in response:
College and University Benefits Study (CUBS) Infographic: Health Trends in Higher Ed Benefit Packages
Many higher education institutions now offer high-deductible health plans (HDHPs) as part of their benefit packages. Sibson’s study also found increased use of prescription drug cost management programs, and a significant percentage of institutions offering various wellness incentives.
College and University Benefits Study (CUBS)
Infographic of Key Facts about 2016 Medical Stop-Loss Coverage
Interest in stop-loss coverage has grown since the Affordable Care Act eliminated annual and lifetime dollar limits on essential health benefits — and as the number and value of high-amount claims has risen. This infographic presents 2016 data drawn from more than 200 Sibson Consulting health plan clients that have stop-loss coverage.
Infographic of Key Findings from the 2016 Segal Health Plan Cost Trend Survey
2016 Segal Health Plan Cost Trend Survey
The following are among the key survey findings:
It is important to keep in mind that medical health plan cost trends still dramatically outpace the consumer price index for all urban consumers (CPI-U). As long as medical plan trend continues to be substantially above core CPI (which is used to increase the Affordable Care Act’s 40 percent excise tax threshold), a growing number of health plan sponsors will likely exceed the Affordable Care Act’s excise tax threshold in the years ahead. Consequently, plan sponsors will need to continue to focus their efforts to decrease health care spending before the excise tax on high-cost health plans goes into effect in 2018. It is important to make projections now to determine whether (or when) a plan will be subject to the excise tax in 2018 and beyond.
Progression of Health (Conceptual Model Foundation)
Many organizations are experiencing the toll that an unhealthy workforce takes, with resulting increases in health and absence costs as well as lost productivity. How can employers reduce the cost of health care? One approach is to implement a wellness philosophy. A strong wellness philosophy incorporated into all phases of how the employer operates can deliver excellent results – but requires an investment. Actuaries can help to ensure that organizations allocate their investment in the most effective and productive way.
Sibson Consulting recently partnered with the Society of Actuaries (SOA) to develop an evaluation and planning model for wellness programs that incorporates a wide variety of economic, environmental and social factors that impact health, lifestyle behaviors and the effectiveness of an organization.
Sibson’s holistic actuarial model approach can help your organization’s leadership make better, more informed decisions about reducing health costs by implementing the right wellness initiatives – and our experts can guide you in how to best communicate objectives to your employees.
For the full report, please visit the SOA website and click on the Study Report.
To learn more about how Sibson’s actuarial conceptual wellness model approach can help you implement a cost-effective wellness design to help reduce costs to your existing health programs and create a healthier workplace, please contact your Sibson consultant or Len Spangher, Vice President & Senior Health Consultant, one of the study’s authors.
Annual Compensation Planning Analysis Flat, Consistent with Last Year’s Results
Sibson Consulting's Annual Compensation Planning Analysis indicates that salary-increase budgets will stay flat and relatively consistent with last year’s results.
“In 2014, salary-increase budgets were 3.0 percent for both executive and exempt jobs, up slightly from 2013 results, while non-exempt jobs remained at 2.9 percent,” commented Jason Adwin, Sibson senior vice president. “These results are still below pre-2008 levels, which were typically in the 3.5 - 4.5 percent range. For 2015, a 3.0 percent increase is projected across all job classifications.”
Sibson's Annual Compensation Planning Analysis of projected and actual salary-increase budgets and structure salary-range adjustments provides data for three broad job classifications—executive, exempt and non-exempt— in 11 distinct industry groups:
Infographic of Key Findings from the 2015 Segal Health Plan Cost Trend Survey
“Health benefit plan cost trend rates for 2015 are forecast to drop slightly for some coverage, but increase substantially for prescription drug plans,” said Edward Kaplan, National Health Practice Leader. “As the health benefits landscape continues to change, sponsors of large group plans must stay focused on exploring health plan strategies that produce high value medical benefits with stable cost trends.”
These are the key findings from Segal Consulting's 2015 Health Plan Cost Trend Survey.
2015 Segal Health Plan Cost Trend Survey
Health benefit plan cost trend rates for 2015 are forecast to drop slightly for some coverage, but to increase substantially for prescription drug coverage, according to data compiled in the 2015 Segal Health Plan Cost Trend Survey, Segal's eighteenth annual survey of managed care organizations, health insurers, pharmacy benefit managers and third-party administrators.
Trend is the forecast of annual gross per capita claims cost increases that takes into account various factors, such as price inflation, utilization, government-mandated benefits, and new treatments, therapies and technology. Although there is usually a high correlation between a trend rate and the actual cost increase assessed by a carrier, trend and the net annual change in plan costs are not the same. Changes in the costs to plan sponsors can be significantly different from projected claims cost trends, reflecting such diverse factors as group demographics, changes in plan design, administrative fees, reinsurance premiums and changes in participant contributions.
Notable findings from the survey include the following:
The survey also examined 2015 projected medical trends by service type (hospitals, physicians and prescription drugs). Similar to prior-year projections, price inflation remains the largest component of cost increases.
The key findings from Segal’s 2015 Health Plan Cost Trend Survey are illustrated in an infographic that can be found here.
Infographic of Results from Sibson's Latest College & University Benefits Study
Leaders of universities and colleges are extremely interested in how the benefits they provide compare to the offerings of their peers. Sibson Consulting has an extensive database of benefits offered by more than 600 higher education institutions, including differences among the benefits offered to faculty, administrative and clerical staff. Sibson draws on that database for its College & University Benefits Study (CUBS).
An infographic of selected results from Sibson’s latest CUBS presents the study findings on the following benefits:
Report of Results from Sibson's First Annual College & University Benefits Study
Higher education institutions are extremely interested in how the benefits they provide compare to the offerings of their peers. Sibson Consulting designed and conducted a College & University Benefits Study (CUBS) to collect detailed information about higher education institutions’ benefits, including differences among the benefits offered to faculty, administrative and clerical staff. This report gives an overview of the results from Sibson’s first CUBS, which covers benefits offered in 2012 by over 600 institutions, as well as institutions’ health plan strategies for 2013.
Key CUBS findings include the following:
The report concludes with observations on the findings, comments on opportunities that institutions may want to consider and some notes about developments that may affect the outlook for benefits.