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Very few of us actually understand the consequences of our health care decisions. For a $20 co-payment, we can get a cholesterol-lowering drug that costs $100 per month rather than change our diet or increase the amount we exercise. But, if we had to pay full price for our prescriptions and other medical care, most of us would consider these expenses more carefully before dipping into our own pockets.

This is the behavior some employers are hoping to spark by offering "consumer-driven" health plans (CDHPs).

Under a consumer-driven health plan, an employer still contracts with insurers to purchase group insurance and retains some measure of control over health insurance purchasing decisions. CDHPs often give employees more choice in terms of benefit options, allowing them to choose their own deductible levels based on individual needs. In turn, these options also increase their share of the costs and risks associated with health care.

For example, let's say that benefits under a CDHP cover the first $500 to $1,500 of an employee's medical care costs per year. After this level is reached, employees are responsible for all additional expenses until a pre-selected deductible has been met, usually somewhere between $1,000 to $3,000. Once this annual deductible is reached, the insurance plan kicks in and covers say 60 to 70 percent of medical costs for an out-of-network provider or say 80 to 100 percent for a provider within an established network.

Now, if the initial $500 to $1,500 given to the employee is not spent, an employer can setup their plan to have any remaining amount rolled over to use the following year by that employee. But, because the employer retains ownership of this account, any funds left over if the employee leaves the company are forfeited.

Plans such as these are so new that there is no way to judge their overall impact on health insurance costs or how widely accepted they will be by employers and employees. What is for sure is that these plans seem to be picking up steam within the industry.

It goes without saying that the growth of CDHPs will adversely affect Pharmacy Benefit Managers (PBMs), and despite the unprecedented growth and popularity witnessed by these plans over the last few years, consumer-driven health plans may leave them struggling to remain prominent and profitable. In fact, PBMs are closely monitoring new consumer directed plans that offer pharmacy-only benefits.

Designed to function much like consumer-driven health plans, members of these plans use their pharmacy savings account to cover prescription drug costs. Any unused funds can be rolled over to the next year.

Other similarities between the new pharmacy-only consumer directed plan and consumer-driven health plans are the concerns for decreased utilization, and the perception that both plans punish people with chronic conditions such as asthma, diabetes, heart disease, high blood pressure, or mood disorder.

According to the Yale School of Medicine, asthma, diabetes, heart disease, high blood pressure and mood disorders cost Americans more than $62 billion a year in treatment and prescription drug costs. Critics of both the consumer-driven health plans and the new pharmacy-only consumer plans are concerned that "consumerism" will force employees to skip needed care or medical treatment, and forego on filling important, needed prescription drugs. Only time will tell.

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