October 23, 2017
In recent years, a new trend has crept
into the already high-cost pharmaceutical industry—new, expensive drugs for
which lower-cost alternatives are readily available are slipping into claims
unnoticed, unnecessarily inflating drug spend. Feeling the pain from expiring
patents, pharmaceutical companies are hoping to extend the life of patent
protection by creating new brand prescription medications from already approved
drugs—their own or generics—and marketing them at significantly higher prices.
For example, Duexis® and Vimovo® are brand
drugs that are actually just a combination of generic drugs. Although safe and
effective, these non-essential drugs provide little to no clinical value over
their lower-cost alternatives, but cost drastically more.
“The prevalence of non-essential drugs has
increased significantly over the past several years as many patents have
expired,” said Kel Riley, chief medical officer for EnvisionRx. “Mitigating
this trend can be a challenge, as these drugs aren’t likely in the spotlight
like a specialty drug or biologic. When we evaluate the data for potential new
clients, we often see these drugs showing up in their claims, completely
unnoticed.”
While formularies are one, very important tool
for managing unnecessary drug spend, many don’t address non-essential
medications, quite simply because they’re hard to find. These medications don’t
typically fall into a specific therapeutic class or even dollar amount per
fill. They don’t set off any alarms and, in many cases, the manufacturers are
advertising their medications to doctors and direct to consumers, often
offering coupons and discounts to encourage use.
But someone has to pay the difference, and
that someone starts with the payer. However, with 89% of covered employees on a
cost-sharing plan as payers look to better manage rapidly rising drug costs,
that means those costs will typically be shifted to the member, making patient’s
out of pocket even higher.
Identifying
Non-Essential Drugs Saves Up To 60% Per Prescription
With no way to stop these drugs from being
filled short of evaluating every single prescription presented, EnvisionRx
started compiling a list of these non-essential drugs. As of the time of this
post, we have approximately 160 of these medications on our Non-Essential Drug
List. These medications include new formulations and combination packages, as
well as high inflation products.
Envision clients can add the Non-Essential
Drug List as an overlay to their formulary strategy. If a member tries to fill
a prescription for a non-essential drug on the list, they are provided with a
clinically sound alternative approved by our Pharmacy & Therapeutics
committee, comprised of independent clinical experts. Members have the
opportunity to save on their medications not just short term with a coupon, but
long term using the most cost-effective and clinically effective medication.
“We introduced this program to give clients an
additional option to help balance the need for delivering clinically effective
benefits with the economic impact to the plan, while providing the best member
care experience possible,” stated Jane Lyons, general manager, Commercial and
Managed markets at EnvisionRx. “There is no cost to the plan to participate in
this program and they can expect to see savings as much as 60% on individual
prescriptions.”
The NED program is a win-win for everyone.
Members get the medications they need at more affordable prices, and payers
have an effective tool to better control unnecessary drug spend.
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