OTC medications and products are valued at $102 billion annually for the US healthcare system.
According to the study, 60 million Americans would go without treatment due to high healthcare and prescription costs. OTC benefits help these individuals get relief affordably and conveniently without the need for a prescription.
When ailments are untreated, the condition can worsen and result in even more expensive procedures or life-threatening illnesses.
Companies looking to provide OTC benefits should rest assured that through OTC benefits, they are helping decrease their employees’ clinical visits and healthcare costs. Employers are ultimately increasing their members’ chances of staying healthy.
According to a review of the 2019 Annual Enrollment Period Supplemental Benefits, OTC programs are growing and outpacing other supplemental benefits such as meal delivery services, in-home support services, and adult day care services.
If your company is looking to choose an OTC benefit company, read on to learn all about costs, how it works, how to select a good program and how the benefits add value.
How OTC Benefits Add Value
Without OTC benefits, members must purchase expensive prescriptions that they may not be able to afford, and unfortunately, many choose to go untreated due to costs.
Going untreated can leave many to suffer through ailments and many to succumb to worse health problems resulting in emergency room visits, surgery, and more expensive treatment.
OTC medications and products help bridge the gap between needed treatment and affordability. OTC products are convenient, readily available, and easy to access.
OTC benefits can help provide a healthy workplace, increase member retention, and achieve higher satisfaction. This benefit gives members a chance to be proactive with their health and choosing what is best for their health without worrying about costs.
How an OTC Program Works
An OTC benefits program works by having OTC products partially or fully covered for members.
Members will buy OTC medications and products instead of prescriptions. Then they will get reimbursed for qualifying purchases.
Depending on the program, members will have the ability to purchase items through regular retail outlets, online through health plan portals, over the phone, through an app or by mail.
Some programs give members a benefits card that they can use at stores.
OTC programs must provide an easy-to-read catalog of products that are covered, so members know that what they are purchasing will be reimbursed.
An OTC benefits plan will give members a certain amount of credits per a specific period. Some programs allow credits to roll over to the next period.
When members purchase OTC items through a reimbursement plan, they must show documentation of the purchase, such as a dated receipt and a copy of the prescription.
How Much Does an OTC Program Cost
When choosing an OTC benefits program, companies will want to keep costs in mind, as with any health plan.
Depending on the program the company chooses, their cost to enroll a single member could be around $30 per month. This fee includes account and membership administration along with marketing efforts.
Overall, investing in OTC benefits can result in healthcare savings. OTC medicines are easily accessible and affordable. Every dollar spent on OTC products saves $7.20 for the US healthcare system. These savings are from lower drug costs and fewer doctor and emergency room visits.
Costs aside, a study in Health Affairs reported that offering OTC benefits can result in higher member satisfaction and increased retention rate.
Choosing an OTC Benefit Company
There are plenty of OTC benefit companies from which employers can choose. When choosing the benefits program to partner with, companies need to look out for certain qualities.
All OTC benefit companies need to be compliant with CMS regulations and have security procedures.
Companies need to make sure that the program is generating internal audits, financial reports, and CMS-required reports to prove that they are adhering to regulations and are compliant.
Then companies should look for security procedures. They should be certified and abide by HIPAA and privacy laws.
After getting assurance on compliance, companies can then research further to see what the program offers, the cost, and what use members will get out of it.
What to Look for in a Good OTC Benefit Company
When choosing an OTC benefit company, look for one that puts members first. Members are the heart of these plans and need to be taken care of.
A good OTC benefit company will have a comprehensive call center where members can have access to highly-trained representatives.
Members should have clarity, confidence, and convenience. They should have their benefits information delivered to them in an easy to read and understand fashion.
They should know their credit balance at all times, and they should be confident that their plan covers the products that they are purchasing.
Having a service for at-home delivery is a feature a company wants to look for when choosing an OTC benefits company. At-home delivery helps bring needed medications to members who are sick, disabled, or have a lack of transportation.
Thinking of Choosing an OTC Benefit Company?
Companies will have plenty of options when choosing an OTC benefit company. Choosing the right one for them will require a little bit of research.
You can start with the health plan you already have to see if they offer this benefit. If not, you will need to find another health care provider who does offer OTC benefits.
Knowing how the OTC program will work and understanding the features it can come with will help you during the decision-making process. Companies will want to choose a plan that will put their members first.
Members’ shopping experiences need to be easy and convenient. Members with a lack of transportation need to have access to medications.
Reimbursements need to be straightforward, and the catalog of products must be easy to read.
Along with a comprehensive call center for members, companies need to make sure their OTC benefit company is compliant, secure, and up to date with laws and regulations.
Offering OTC benefits to members provides a great experience and healthier people.