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Price continues to drive prescription drug trend
Price continues to be the main driver of the prescription drug trend, according to CVS Caremark’s annual Insights Report.
“Across our book of business, we saw significant inflation for traditional brands, specialty drugs and generics,” says Jon Roberts, executive vice president, CVS Caremark Corporation and president of CVS Caremark Pharmacy Services. “We also saw the first significant increase in utilization as consumers filled more prescriptions after several years of flat utilization during the recession. While specialty drug trend was down slightly from 2012, it is still higher than traditional and generic trend, driving up overall trend.”
The Insights Report offers five strategies to help manage the prescription drug trend in the coming years.
1/ Double down on generics
“We believe not every plan has maximized the existing generic opportunities,” Roberts says. “We encourage clients to evaluate generic utilization by therapeutic class and/or consider managed formulary options to achieve their plan goals.”
2/ Look across benefits
“Once our clients have established the foundational strategies needed to manage the specialty pharmacy benefit, we encourage them to look further,” he says.
For example, CVS Caremark works with them to get a better grasp of specialty medications billed under the medical benefit that could be better managed under the pharmacy benefit.
Copayment and prior authorization structures are also reviewed to see if they best support cost-effective choices in both self-administered and clinical-administered specialty drugs.
3/ Tackle price
Consumers are concerned about costs and are more willing than ever to trade broad access for savings, according to Roberts.
“Narrow networks are becoming more common across a spectrum of plans. We have also found that our Maintenance Choice program that provides members the choice of receiving their 90-day chronic medications through mail service pharmacy or at their local CVS/pharmacy to be an effective strategy for many of our clients and their members,” he says.
4/ Strategize cost share
“It is clear that member cost share affects where prescriptions get filled and which drugs members ask for,” Roberts says.
“It can also impact whether a prescription is actually filled. We think it is important that clients align their cost share strategies with overall plan goals and provide support to help their members understand their prescription therapy,” he adds.
5/ Consider the big picture
Whole patient care can reduce hospitalizations, readmissions and ER visits; helping manage overall healthcare costs.
“As prescription drug trend rises, healthcare payers can implement a number of strategies to reduce costs while keeping patients healthy,” Roberts says. “These include maximizing generics, considering narrow networks, encouraging 90-day prescriptions for chronic conditions, improving medication adherence and caring for the whole patient.”