Co-pay Discount Cards = Poor Value

At least in most cases.  Express Scripts recently dropped 48 brand-name drugs from their preferred formulary.  The drug companies offer co-pay cards for 93% of them.  You should consider asking your PBM for their approach to these same drugs.

Here's a link to a list of co-pay cards and coupons.  If you see a drug on this list it likely means it is unnecessarily expensive.

Can generic discount programs save you money?

This publication suggests that generic discount programs (e.g., $4 generics) results in ~10% fewer levothyroxine prescriptions being submitted to the PBM for adjudication.  Sounds good until you balance the savings against the loss of data for clinical programs.  Saving 10% on inexpensive medications will have a very limited impact on your medication costs and trends.

Not having these claims will weaken your point-of-service programs (e.g., interaction) checking and other clinical programs such as care gap alert systems (e.g., poor adherence) and care management services.  It doesn't take many patients with a potentially avoidable hospital admission to wipe out the savings.

Consider making these same drugs a $4 co-payment or less with your benefit.  Then inform your beneficiaries that they have a comparable program available through their benefit program and can be used at any pharmacy in your network.

I estimated the additional waste created by 90-day supplies at 4-5%

A recent publication from Walgreens employees suggests a lower amount of waste.  The primary difference likely results from their calculating waste only from switches to a different strength or medication.  My analyses also included patients that discontinued therapy for a condition.  This commonly occurs approximately 6 months after starting a medication.  Conceptually, a patient would "waste" an average of 15 days of medication following discontinuation of a 30-day supply.  Patients with a 90-day supply would waste an average of 45 days of medication.

I prefer 30-day supplies when a program includes an alert identification and notification system that relies on claims data.  This allows the system to identify potential gaps in care sooner than with 90-day fill intervals.

The op-ed piece in the same journal also explains some caveats related to this study.

"And then she presented this card"

NPR reports on the use of drug company coupons to subsidize the cost of brand drug co-payments.  But what's the big deal if the drug company makes up the difference between their drug and the generic alternative?  Here's the payments for the Solodyn example:

Patient:  $10
Drug company (Medicis):  $154.28
Insurance:  $462.84 (est.)

Most of the insurance payment goes back to the drug company.  They probably made over $300 for a one-month supply of a once-daily version of generic minocycline (~$40).  But my favorite part of the story was when the doctor didn't offer the savings card until AFTER the patient complained about the price.  How many people get to pay the $154 or even the full price?

Some plans now use reference pricing to counter these efforts.  This requires the patient to pay the full amount above what the insurance would have paid for the higher value alternative.  Another method would require the patient to pay the full amount up front, like indemnity insurance, then get reimbursed for the covered amount.  This helps patients understand the true costs of their treatment.

What do you get for an extra $600 per month?  Because Solodyn results in lower blood lets it MAY cause less vestibular effects (e.g., dizziness, tinnitus).  Maybe that extra money will go towards a direct comparison to prove that possibility.

 

Lowering Patient Pay Only One Way to Improve Medication Adherence

Peter Pitts of the Center for Medicine in the Public Interest (partially funded by drug companies) and a former FDA associate commissioner argues that lawmakers should include reducing patient pay as a key part of health care reform.

I argue in a recent issue of American Health & Drug Benefits that other methods may work better at a lower cost. Excerpt:

"Programs to help patients maintain adherence can focus on incentives (such as lower patient pay), refill reminders, or interventions supported by analytics that detect adherence issues. Lowering copayments or coinsurance provides an easy-to-implement solution with proved short-term benefits; however, little is known about the long-term, lasting impact of this approach. Other potential incentives may tie lower patient pay, contribution to health savings accounts, or lower deductibles to completion of health risk assessments, participation in disease management programs, or maintaining adherence for defined durations (eg, every 6 months). This begs the question whether lowering patient pay offers better value than other services, such as those that detect and notify providers of poor adherence. Lowering patient pay by $5 for every chronic medication would cost upwards of 10 times more than intervention services that focus on adherence plus other medication therapy problems, missing preventive services, and gaps in evidence-based care."