Sales of lifestyle drugs are booming.
Fueled by growing demand from an aging population, the market for drugs used to treat conditions such as infertility, hair loss, erectile dysfunction, obesity and wrinkles has grown to more than $23 billion.
When you, the producer, visit employers that sponsor self-insured health plans, you may find that managers are on one side of the benefits fence, shaking their heads at a new round of double-digit increases in prescription drug expenditures.
The employees are on the other side of the fence, asking why their employers wont cover the cost of nicotine patches that could ultimately decrease the cost of treating lung cancer. Or why their employers will cover antibiotics for minor earaches but wont cover creams used to treat disfiguring acne.
How can you help your clients break down that fence?
To develop a consistent policy that will meet the wants and needs of a plans members while ensuring that plan resources are allocated appropriately, the plan sponsors will have to consider each lifestyle drugs safety, efficacy, outcomes and cost.
One problem with coping with the cost of lifestyle drugs is the fact that there are no clear-cut guidelines for deciding which drugs should be classified as lifestyle drugs.
Keep in mind is that the term "lifestyle drug" could refer to an off-label use of a drug used to treat a serious medical condition.
Lifestyle drugs include drugs used primarily for cosmetic reasons; drugs for conditions that might not necessarily be medical problems, such as erectile dysfunction; and drugs that treat medical conditions that many people believe to be the result of poor lifestyle choices, such as smoking cessation drugs and weight loss drugs.
Not surprisingly, coverage of lifestyle drugs varies greatly from one plan sponsor to the next.
A study by Deloitte & Touche L.L.P., New York, showed that plans often provide some coverage for drugs used to treat obesity and sexual dysfunction, but that plans rarely provide any coverage for drugs used to treat hair loss and signs of aging.
Plan sponsors that are considering adding coverage for lifestyle drugs would do well to call in the services of a PBM.
