By André Wencker, September 2019

In a previous 2018 article, based on a landmark study from the Health Care Cost Institute, we reported that health care spending is highly concentrated on a small number of people who account for the lion’s share of the health care cost in a given year.

“5% of the people account for more than 50% of the spending, and this share is growing year after year “Top-Spenders” had also high Out Of Pocket expenses. This group changes from year to year as some people experience serious illness and recover, but roughly 40% of that group, that HCCI called “Permanent Top-Spenders”, continue to experience high spending for extended periods.”

A new study published by the Kaiser Family Foundation in July 2019 sheds more light on these “Permanent Top Spenders”, whose health spending was in the top five percent in each of the three years (2015-2017) covered by the study.

Overall, these patients with persistently high spending represented only 1.3% of the continuously covered subgroup but accounted for nearly 20% of the total spending in the final year of the period studied (2017), averaging a whopping $88,000 per year!

The KFF team considered that “their extensive health care need and predictably high spending make them an important focus for any efforts to improve value and quality.”

A large proportion of these Permanent Top Spenders had claims in the first year pertaining to a limited set of diagnosis, all involving heavy medication supplies.

Prescription drugs account for about 40% of this group’s costs, compared with below 10% for the country as a whole.

This is precisely where Care2care can help you make a big difference and generate savings for all parties involved. Our Pharmacy Travel solution is particularly adapted to smaller, targeted groups of plan members that your TPA’s case management team can easily reach out. 1.3% means 13 individuals in a group of 1,000 covered lives whose Rx spending accounts for almost 8% of your entire health care costs! Through the design of a specific incentive program, adapted to your culture and resources, your HR team and healthcare advisers can team up with Care2care to look for prescription drugs with cost savings frequently between 50% and 75%, meaning immediately saving 4% to 6% of your entire health care budget!

For more on this and a detailed pricing differential of a selection of specialty drugs that your members can bring home every quarter, please download our most recent list here. Please ask us for a quote on any other medications not listed here.