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Corporate benefits managers are charged with evaluating and choosing benefits packages that balance adequate coverage with cost-effectiveness. Insurance companies and benefits consultants often recommend cost-saving strategies that control patients’ access to healthcare services—practices known as utilization management (UM). However, UM can negatively impact outcomes for employees facing cancer and other serious illnesses.

The Employers’ Prescription for Employee Protection Toolkit: Best Practices for Prescription Drug Benefit Design is a comprehensive guide to help benefits managers, human resources professionals, and executives better understand UM. This toolkit will help you achieve a deeper understanding of UM practices and their unintended consequences on the health and well-being of your employees. The Toolkit also provides the tools you need to create a strong, patient-focused prescription coverage plan that can reduce your costs on the medical benefits side and increase employee productivity and satisfaction.

What's Included

Section 1 provides an introduction to UM and looks at how UM policies intersect with benefit design decisions that impact employers and employees alike. Alongside current research, you’ll find expert perspectives from HR executives, doctors and benefits consultants. The illustrated explainers provide a closer look at seven common UM practices and their consequences. Several are paired with Case Studies shared by patients who have experienced, firsthand, the negative consequences of UM practices.

A video series focusing on specific UM topics is designed to take these concepts and show how they work in the real world.

Section 2 brings together resources for working with benefits consultants and insurers to create a strong prescription coverage plan. It includes best practice recommendations to guide plan design and questions that will help employers evaluate health plan options and UM policies.

Explore the Toolkit

Section 1: About Utilization Management

  • An Overview of Utilization Management (UM)
  • The Role of Pharmacy Benefit Managers (PBMs)
  • Innovations in Cancer Care vs. UM
  • Working With Benefits Consultants
  • What Employers May Not Know
  • The Costs of UM to Employers
  • Common UM Practices & Consequences
  • Illustrated Explainers: Common UM Practices & Consequences
  • Case Studies
  • Videos

Section 2: Resources for Employers

  • Key Take-Aways for Benefit Design
  • Pharmacy Benefit Plan Recommendations
  • Request for Proposal (RFP) Questions to Ask

Glossary of Terms & Works Cited
Acknowledgements

Resources for Employees

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