There seems to be enthusiasm as we all turn our backs on 2021. Enthusiasm for 2022 is coming with a much more cautious tone. In a general sense, it seemed for each challenge we conquered in 2021, there were two new challenges waiting in the shadows. The world of pharmacy benefits followed this trend and National CooperativeRx continues to meet these challenges head on representing the financial interests of employers and the health of their employee population.
Membership Expansion
In 2021, 42 new members joined the Cooperative with an expected count exceeding 60,000 new lives. Off the back of an aggressive new pharmacy benefits management contract, this growth represents the second highest level of new lives added in the history of the Cooperative. With strong renewal of existing members, we expect the Cooperative to exceed 405,000 total lives when final numbers come in. This is the first time our buying strength has exceeded 400,000 lives.
Another significant area of growth is in new states. This growth brings seven new states to the Cooperative’s reach, making a total of 29 states with Cooperative members. The new states are: Arkansas, Arizona, Connecticut, Florida, New Jersey, New York, and South Carolina. We continue to have covered lives in all states.
Financial Strength
With financial impacts of the pandemic largely being reduced expenses, the Cooperative’s strong financial performance continued in 2021. With lower expenses, more dollars flow to the Cooperative’s bottom line. We are again expecting a strong dividend for 2021 with net income exceeding $800,000. Our solid financial position continues to allow for early equity retirements and continued investments that add additional value for our members.
Legislative Activity
2021 actions in Washington D.C. have made prescription drug price reform seem more possible than ever before. As momentum built, so did the prospect that employers would benefit from price reforms. With reforms currently stalled, there is again fear that any reforms passed will focus on Medicare and Medicaid only and leave employers exposed to shoulder more of the increase.
Reform continues to happen individually within many states. At last count, there were over 600 bills proposed across the nation under the idea of prescription drug reform. More than 100 of these bills passed, although most do little to lower costs for employers and do more to increase costs. Pharma, pharmacies, and patient advocacy groups were successful in getting some states to pass legislation limiting copays on insulin mediations, banning programs that remove copay coupon value from out-of-pocket maximum calculations, and limiting use of other programs pharmacy benefit managers offer to control employer costs.
Cooperative-Led Rx Cost Controls
Cooperative staff are often asked what can be done to control prescription drug costs. We can make the answer as easy or as complex as one would like. It would never involve waiting for legislative reforms, as history tells us health plans who use that strategy will be waiting awhile.
Prescription drug cost control starts with a solid pharmacy benefits management contract. The Cooperative is regularly assured of the best-in-class status of our contract by outside brokers and consultants who run regular competitive bids. Rest assured plans with National CooperativeRx have a solid contract.
Oversight over fraud, waste, and abuse is another key to controlling prescription drug costs. Here too the Cooperative has our members’ best interest in mind. In one example from 2021, our clinical team identified an $8,000 per month savings opportunity through a simple brand to generic switch, at no health or financial impact to the patient. In another example, a $130,000 per month medication was found being used off-label, potentially risking the health of the patient, and charging the employer health plan for non-evidenced based treatment. Although often lower in cost, examples like these are intervened on every day by our clinical team.
Employer-Led Cost Controls
Employer engagement is needed to control costs when it comes to plan design and engagement of the patient population. Although the pandemic has limited interactions and employer desires to change plan designs, the Cooperative team stands ready and eager to engage with members and deliver best-in-class recommendations. Cooperative members can be assured we have the plan’s best interest in mind as we make no additional revenue for any of the recommendations we make.
Patient engagement is an untapped opportunity, both in the pharmacy benefit and health plans overall. Through September of 2021, the Cooperative stood at just 10.4% of its population being registered users and 4.4% being active users on CVS’s website. A more engaged patient is more educated about items such as lower-cost alternatives, is more adherent to medications taken to control diseases, and is more satisfied with their health plan.
Entering our 19th year, National CooperativeRx was founded to bring purchasing power and expertise to pharmacy benefits management. We know employers are busy and don’t have time to focus on this ever-changing industry. It gives us great pride that so many longstanding members signed our new three-year contract and continue to follow our best-in-class management recommendations. We look forward to furthering the trust with our new members and representing all during these difficult times. We wish you a Happy New Year!
