The Hidden Costs of Insurance

Why are my premiums so high?

Insurance premiums can be shockingly expensive. Many factors contribute to the high cost of insurance premiums; becoming informed about each factor is the first step to addressing the problem. Information is key.

The price of prescription drugs is a major factor driving the cost of health insurance premiums. Many times, cost-effective options are hidden in the processes established by insurance providers. In the United States, health insurance providers are required to offer plans that cover essential benefits, but they are not required to disclose all the costs and alternatives. Prescription drugs range in cost from very affordable to astronomically expensive. Even though they are often undisclosed, these costs contribute to the cost of premiums.

Insurance premiums are confusing to the patient, the doctor, and the employer providing the benefits. Often, the only individuals who understand are the insurance providers themselves. Unfortunately, it is common practice for  providers to keep as much information hidden as possible. Though there are many variables to consider in each individual circumstance, a case study can help with understanding the alternatives to high prescription costs

Case Study: Monthly Savings of $9416

A few weeks ago, an ECCHIC client reached out. They had been informed that one of their participants had a new prescription that was going to cost $9500 each month. The annual cost of $114,000 would significantly impact their overall plan, likely raising future premiums. 

The team at ECCHIC was concerned about the probable increased premiums and hidden costs. One of our pharmacy benefit consultants investigated the matter and was able to find four other comparable prescriptions with significantly lower costs.

We sent that information to the employer, who then shared the information with the participant. In turn, the participant visited his doctor to inquire about the alternative medications. The doctor immediately responded that the medication with an $84 monthly price tag was perfectly fine and rewrote the prescription. This relatively simple solution cut the cost to that employer plan by nearly $113,000 per year for the foreseeable future while the participant needed this medication.

Further, this annual cost would have driven premiums up for participants and the employer. With each increase, the company and employees would have felt the impact with no knowledge of why.

What can we learn from this case study?

  • Ask questions. Plan participants often pay the copay for their covered prescriptions, unaware of the actual prescription costs and their potential for raising premiums. Similarly, employers pay what is needed for their plan coverage, often unaware of the long-term effects of participants’ medications. From this case study, it is obvious that awareness of the final prescription price and the alternative solutions can lead to tremendous long-term savings.
  • Doctors are on the patient’s side, but they need information in order to help. Often, medical providers do not know the real cost of services or prescriptions. They know what the representatives of pharmaceutical companies tell them. However, they are very often willing to work with patients to provide a reasonably priced alternative when possible.
  • Utilize the services of a pharmacy benefits professional. In this case, the participant and the employer would have been blind to the monthly $9500 spent and the result would have been increased premiums. Everyone in the scenario benefited from the services of the ECCHIC consultant.

This real-life case study illustrates just ONE way we help the employers and clients we work with. Our methods are uniquely designed to provide the best coverage and pricing, taking into consideration not just premiums, but also the hidden costs. We would love to help you! Give us a call at (314) 997-8865 or contact us via our website HERE.

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