PBMs lukewarm to cost-cutting benefits of dose consolidation

Dose consolidation is getting mixed reviews as a cost-cutting strategy according to pharmacy benefits managers (PBMs). While a study by St. Louis-based Express Scripts indicates that savings opportunities are limited, other PBMs have realized more value. With prescription drugs accounting for 10% of total healthcare expenditures, according to the California Healthcare Foundation's third "Health Care Costs 101" report, a variety of strategies are worth exploring.

Dose consolidation programs note that two doses of a drug at a certain strength cost the same per tablet/capsule as a higher-strength single dose, thus the two doses cost twice as much per day.

Emily Cox, senior director of research for Express Scripts, says that the potential savings from dose consolidation may not be sufficient to justify the costs by plan sponsors to educate physicians and patients on the benefits of moving to a once-daily dose. The small number of changes resulting from the letter campaign did not produce enough savings.

Findings further suggest that substantial regimen discontinuation along with consolidation naturally occurring during the course of drug therapy resulted in fewer opportunities for consolidation, thus producing limited savings.

Delate also points out that some medications in a single dose may tax the kidneys and cause other side effects. In addition, he notes that while no data support it, antipsychotics prescribed more than once a day may help ensure that patients take at least one of the multiple doses.

Robert Oscar, president of RxEOB headquartered in Richmond, Va., provider of consumer-directed pharmacy benefit software for health plans, concurs with the study results. "The concern is that the cost of traditional physician education, mailings and prior authorization programs often cost more than the savings generated," he says. "The goal is to lower the cost of programming to encourage dose consolidation. The use of less-expensive programs such as secure Web messaging, point-of-sale edits and e-prescribing messaging support may make dose consolidation more cost-effective." He says, however, that more studies are needed to prove the effectiveness of these programs.

ANOTHER POINT OF VIEW

On the other hand, CIGNA Pharmacy Management in Bloomfield, Conn., considers dose consolidation, along with prior authorization, step therapy and the use of generics, a cost-containment benefit ensuring the lowest net drug cost to the member and payer. CIGNA has employed the strategy since September 2001 for its fully insured customers.