As this year draws to a close, the Express Scripts Lab staff reflected on the events of the past 12 months and their impact on the pharmacy benefit industry and healthcare overall. 2012 was certainly a game-changer, and the following 6 events could have a lasting effect on our health, the decisions we make and the delivery of care in the years ahead.
- Affordable Care Act (ACA):
The future of the ACA was uncertain at the start of 2012. Then came the Supreme Court’s affirmation of much of the ACA in June, and then President Obama’s re-election in November. While some governors are not embracing Medicaid expansion and state-run exchanges, health care organizations around the country are gearing up to implement the law’s major components. The ACA emphasizes accountable care and consumer choice, placing increased importance on each patient’s ability to make better decisions about their health.
- Patent Cliff:
2012 was an historic year for patent expirations, with popular medications like Plavix®, Singulair® and Lexapro® becoming available in generic form. Despite the savings potential, many patients still aren’t taking advantage — last year alone $49 billion in brand-name drugs were dispensed when a generic equivalent was available. With all of these new generics available, and more to come next year, there is abundant opportunity to reduce prescription drug costs in 2013 and beyond. The Express Scripts Prescription Price Index shows that, since 2008, price increases for the most highly used brand-name medications outpaced overall consumer inflation by more than six times. In short, if you continue to use a brand when a generic equivalent is available, you’re being charged a higher premium than ever before.
- Big Data:
Big Data, which offers promise and opportunity to improve just about anything, entered healthcare in a real way in 2012. If this focus on analytics is going to reach its potential, the data must be actionable. One such actionable example is Express Scripts’ ScreenRx™, which leverages data (more than 400 different factors) to detect patients at risk for future medication nonadherence, a problem that costs the country $317.4 billion a year in unnecessary medical expenses. With the data from ScreenRx, we can reach out to each at-risk patient and tailor a meaningful intervention to avoid waste and improve outcomes.
- Narrow Retail Pharmacy Networks:
One of the prevailing themes in the Express Scripts’ 9 Leading Trends in Rx Plan Management report is that payers are changing their benefit philosophy for the first time in 5 years, from “providing the broadest coverage” to “balancing cost with care.” Optimizing retail pharmacy networks to create the highest quality, most cost-effective network is one way payers are addressing the care/cost balance. This year, Express Scripts launched our Express Advantage NetworkSM, a new choice-based solution that combines tiered retail networks with member cost sharing. The result is a more affordable pharmacy network – without sacrificing patient choice, access or care.
- The Merger of Express Scripts and Medco:
In April, Express Scripts completed its merger with Medco Health Solutions, enabling the new company to make the use of medicine safer and more affordable for 1 in 3 Americans. The combined company is uniquely able to offer a new approach to pharmacy benefit management: Health Decision Science™ – the application of clinical specialization, behavioral sciences and actionable data. Healthier outcomes require better decisions. And through Health Decision Science, the new Express Scripts has built practical solutions that help with three critical decision areas: drug choices, pharmacy choices and health choices.
- New Obesity Medications:
The FDA approved two anti-obesity medications this summer – Belviq® (lorcaserin) and QsymiaTM (phentermine and topiramate, extended release) — providing new options for patients struggling to lose weight and filling a void in available medications to treat obesity. While both medications have promising results for patients who meet the clinical guidelines for treatment, they will require close monitoring to ensure they are being used most effectively and in conjunction with meaningful lifestyle modifications that will help ensure the long-term success of the weight loss.