In recent years, a new trend has crept into the already high-cost pharmaceutical industry—new, expensive drugs for which lower-cost alternatives are readily available are slipping into claims unnoticed, unnecessarily inflating drug spend. Feeling the pain from expiring patents, pharmaceutical companies are hoping to extend the life of patent protection by creating new brand prescription medications from already approved drugs—their own or generics—and marketing them at significantly higher prices.
For example, Duexis® and Vimovo® are brand drugs that are actually just a combination of generic drugs. Although safe and effective, these non-essential drugs provide little to no clinical value over their lower-cost alternatives, but cost drastically more.
“The prevalence of non-essential drugs has increased significantly over the past several years as many patents have expired,” said Kel Riley, chief medical officer for EnvisionRx. “Mitigating this trend can be a challenge, as these drugs aren’t likely in the spotlight like a specialty drug or biologic. When we evaluate the data for potential new clients, we often see these drugs showing up in their claims, completely unnoticed.”
While formularies are one, very important tool for managing unnecessary drug spend, many don’t address non-essential medications, quite simply because they’re hard to find. These medications don’t typically fall into a specific therapeutic class or even dollar amount per fill. They don’t set off any alarms and, in many cases, the manufacturers are advertising their medications to doctors and direct to consumers, often offering coupons and discounts to encourage use.
But someone has to pay the difference, and that someone starts with the payer. However, with 89% of covered employees on a cost-sharing plan as payers look to better manage rapidly rising drug costs, that means those costs will typically be shifted to the member, making patient’s out of pocket even higher.
Identifying Non-Essential Drugs Saves Up To 60% Per Prescription
With no way to stop these drugs from being filled short of evaluating every single prescription presented, EnvisionRx started compiling a list of these non-essential drugs. As of the time of this post, we have approximately 160 of these medications on our Non-Essential Drug List. These medications include new formulations and combination packages, as well as high inflation products.
Envision clients can add the Non-Essential Drug List as an overlay to their formulary strategy. If a member tries to fill a prescription for a non-essential drug on the list, they are provided with a clinically sound alternative approved by our Pharmacy & Therapeutics committee, comprised of independent clinical experts. Members have the opportunity to save on their medications not just short term with a coupon, but long term using the most cost-effective and clinically effective medication.
“We introduced this program to give clients an additional option to help balance the need for delivering clinically effective benefits with the economic impact to the plan, while providing the best member care experience possible,” stated Jane Lyons, general manager, Commercial and Managed markets at EnvisionRx. “There is no cost to the plan to participate in this program and they can expect to see savings as much as 60% on individual prescriptions.”
The NED program is a win-win for everyone. Members get the medications they need at more affordable prices, and payers have an effective tool to better control unnecessary drug spend.