Drug costs under control while zero copay models thrive
Women saved $483 million in 2013 on contraceptives, or $22.44 per fill
In total dollars, spending on drugs reached $329.2 billion in 2013, an increase of 3.2%, which is noteworthy because the previous year saw a decrease in actual-dollar spending of 1%. However, growth over the past decade remains modest overall, according to a new report by the IMS Institute for Healthcare Informatics.
“Not surprisingly, the IMS study reveals a modest upward fluctuation in prescription drug costs this past year due primarily to growth in specialty drug usage, increases in manufacturer pricing and a diminished introduction of new generic entities to market,” says David Calabrese vice president and chief pharmacy officer for Catamaran, and MHE editorial advisor.
According to the report, little has changed in the dynamics of pharmacy spending, but more importantly, elements of long-term savings such as availability of generics and utilization management have a foothold.
One of the effects of the Affordable Care Act-specifically the mandate that FDA-approved contraceptive therapies be covered with no patient cost starting in 2013-is clear in the data. Women saved $483 million in 2013 on such medicines, or $22.44 per fill. Prescriptions for zero-copay contraceptives increased by 24.4 million from 2012 to 2013 as a result of ACA. A year ago, the rate of increase in women with no-cost contraceptives was 14%, compared to the current increase of 56%.
The commercially insured filled 207 million prescriptions with no copay in 2013, an increase of 44.9 million prescriptions.
Other therapy classes with increasing use of zero-copay models in 2013 include:
Antihypertensives-+2.8 million fills
Mental health-+2 million fills
Cholesterol-+1.5 million fills
Respiratory-+1.4 million fills
A Conversation With Greg Baker, RPh, CEO of AffirmedRx
March 31st 2024Greg Baker, CEO of AffirmedRx, describes his early career, shares some of his critical opinions about the pharmacy benefit management (PBM) industry and how, in his view, his company is offering a better alternative.
Read More
David Calabrese of OptumRx Talks New Role, Market Insulin Prices and Other Topics 'On His Mind'
April 13th 2023In this month’s episode of the "What's On Your Mind podcast," Peter Wehrwein, managing editor of MHE connects with the now Chief Clinical Officer of OptumRx Integrated Pharmacies, David Calabrese. In this conversation, David touches on his transition in January as OptumRx’s former chief pharmacy officer and market president of health plans and PBMs to his new role as Chief Clinical Officer where he now focuses more on things such as specialty pharmacy to home delivery — with an overall goal of creating whole-patient care. Throughout the conversation, Calabrese also touched on the market’s hot topic of insulin prices and behavioral health services within the OptumRx community, among other topics.
Listen
Florida Gets the OK. But Will Drug Importation from Canada Actually Happen?
March 5th 2024Canadian health officials warn that maintaining a drug supply for Canadians is their priority. The staunch opposition of the U.S. pharmaceutical industry may also be an obstacle to imports from north of the border.
Read More
Briana Contreras, editor of Managed Healthcare Executive, spoke with Nancy Lurker, CEO and president of EyePoint Pharmaceuticals. Nancy shared a bit about EyePoint and how the organization’s innovative therapies are addressing patient needs through eye care, and most importantly, she addressed C-Suite positions like the CEO role. Nancy shared advice for those seeking to reach the CEO level, especially toward women in healthcare and other roles, and what it takes to run a biopharma company.
Listen
What Payers Need to Know As Retail Pharmacies Move Into Primary Care
September 6th 2023Healthcare beyond the doors of the doctor’s office has the potential to offer more care to more people. But payers need to think about how to ensure that care is consistent. Regardless of the setting, care decisions must be based on evidence-based content and supported with strong patient education.
Read More
