Pharmacy transparency tools help members make wise drug decisions

November 1, 2005

Just imagine being able to jump on your health plan's Web site and find out exactly what it would cost for a 30-day supply of Lipitor from your local Walgreens store. Or if you prefer a generic delivered via mail order, the cost is also at your fingertips.

Just imagine being able to jump on your health plan's Web site and find out exactly what it would cost for a 30-day supply of Lipitor from your local Walgreens store. Or if you prefer a generic delivered via mail order, the cost is also at your fingertips.

CIGNA Pharmacy Management, headquartered in Bloomfield, Conn., is giving transparency a run for the money with its new Pharmacy Price Quote tool, which drills down to the costs of drugs at one's local pharmacy. Members can look at actual out-of-pocket prescription costs, the plan's cost and the total cost.

The Web-based quote provides real-time prices from any pharmacy in CIGNA's network of more than 52,000 retail pharmacies, as well as from the CIGNA Tel-Drug home delivery pharmacy, and is based on a member's specific benefit plan. The tool also tells members the cost of available generics so that they can compare the price with brand-name drugs.

GIVING CONSUMERS CONFIDENCE

Both Humana and RegenceRx enable members to access the estimated retail price of specific drugs, as well as determining if generic alternatives are available. While Louisville, Ky.-based Humana estimates costs based on a 30-day prescription for a specific benefit plan, the total average cost from RegenceRx, a pharmacy benefit manager headquartered in Portland, Ore., reflects the cost of all strengths and forms of a medication, divided by the number of claims processed for it during the past eight weeks.

This year, there have been 9 million pharmacy portal hits on the Humana Web site, indicating that 25% to 30% of members are asking about drug costs, says William Fleming, vice president, pharmacy and clinical integration for Humana. He estimates that if Humana can touch a member and encourage dialogue with a physician, which results in a prescription change, savings of $240 a year may be realized.

"We are giving members the confidence to make the right decision with appropriate support tools," Fleming says. "By the end of 2007, I hope that we can integrate price and clinical information because it has to be more than just cost considerations. For example, a member could determine how much it would cost to reduce cholesterol by X amount versus paying more but achieving a greater reduction. We want to eventually create an http://Amazon.com/ experience with information just a click away."

David Clark, vice president of pharmacy services for the Regence Group, concurs with Fleming that clinical information is just as important if not more important than cost data; nonetheless, the insurer has pumped up its Web site with access to the approximate costs of drugs. He believes that there is more benefit in shopping among different drug alternatives than among pharmacies. RegenceRx makes members aware of high-quality options through mailings, and works with physicians, studying their prescribing patterns and offering suggestions for prescribing more cost-effective drugs.

The Generic Pharmaceutical Assn., which represents manufacturers and distributors of generic drugs, begs to differ with Clark.

While confirming that generics may cost 30% to 80% less than a brand-name drug, the association says it pays to shop around for generics, reaping savings as large as the differential between generics and brands.