While your pharmacy benefit program has no doubt been managing utilization for years with core strategies, it's important to review effectiveness often. Below are the proven strategies that payers should analyze frequently in the current market of increasing utilization.
First, make sure you're actively reviewing your programs that drive the use of generic drugs. For every for every 1% increase in generic dispensing, plan sponsors tend to save somewhere between 0.5% and 1% of their total drug spend. Most prescription drugs in the United States have a generic alternative available, including some recent blockbuster drugs such as Ambien, Allegra, Zoloft and Norvasc. To help drive generic use, consider reducing or eliminating generic copays and offering drug-class-specific information campaigns and customized explanation of benefits (EOBs) that inform beneficiaries of the savings available specifically to them by switching to a generic. In most cases, beneficiaries are glad to be informed about the savings they can realize on the drugs they're taking.
Pharmacy plans also should promote over-the-counter (OTC) drug opportunities whenever possible. In the past few years, OTC availability for former prescription-only drugs has risen significantly. Some strategies to consider include:
Keep your step therapy programs current so that beneficiaries are encouraged to use first-line therapy before using the higher-cost drug. Usually, the first-line therapy works and both the beneficiary and the pharmacy plan save money. It is important to conduct a clinical review of medications that could be added to your program at least once a year. Employer savings yield up to $3 PMPM from effective step therapy programs.
Pharmacy plans must effectively communicate with beneficiaries. Educating beneficiaries makes them cost-conscious consumers, which benefits both them and your pharmacy plan. The primary focus of member communications should be to inform and align member health decisions with plan objectives, so regular contact is helpful. In addition to print mediums, successful communication campaigns can include user-friendly Web-enabled education, CDs, videos, posters, signs placed at the point of service, and targeted communications for select beneficiaries following drug utilization review.
Each of these strategies promotes a win-win environment resulting in healthier outcomes, increased member satisfaction and lower costs.
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