With prescription drug costs growing faster than any other component of healthcare spend, payers are sharpening their focus not just on the price tag of any given drug, but also on getting the most value for every dollar spent in the pharmacy benefit.
There are opportunities to eliminate waste and increase efficiencies across the supply chain. By applying data analytics and taking a holistic approach to how medications are prescribed, delivered and consumed, payers and pharmacy benefit managers can do more to control costs while ensuring patients get the high-quality care they deserve.
Prescribers Play an Important Role
It starts in the doctor’s office, where prescribing behavior determines whether a patient receives a low-cost, clinically equivalent medication, or an expensive brand-name or non-preferred drug. Open and easy means of electronic communication between physicians and a PBM, such as Express Scripts’ electronic prior authorization solutions, greatly increases the chance that the best decisions for patient health, safety and cost are made right away.
Data analytics also can provide a glimpse into the doctor’s office by comparing the prescribing behaviors of any given provider, or physician group, to their peers. Benchmarking allows payers and health plans to see which providers are following best practices, so they can be included in preferred physician networks.
This same approach – empowered by tools such as our MediCUBE® diagnostic and data mining platform – also can make doctors more aware of how their prescribing patterns stack up compared with others in their specialty or geography. Reports sent to prescribers can flag opportunities to save money for their patients and for the healthcare system. For example, doctors can see if they’re writing for a lot more brands than generics, or if they’re failing to take advantage of safer and lower-cost home delivery pharmacies for chronic medications.
Data Analytics Can Shape High-Value Networks
Likewise, an analytics approach can deliver greater value in the use of retail pharmacies. Creating pharmacy networks comprised of retailers that do the best job of ensuring their customers’ safety and health can reduce overall healthcare spending by avoiding waste and boosting medication adherence. For example, one of the nation’s largest, not-for-profit Medicare Advantage plans is pioneering a Quality Network Solution with us to reduce the use of high-risk drugs among the elderly, and to ensure patients are properly taking their diabetes, high blood pressure and high cholesterol medications.
Of course, no drive toward greater value in the pharmacy would be complete without addressing the high rate of medication price inflation. According to the Express Scripts Prescription Price Index, the average price for the most commonly used brand-name drugs more than doubled (up 127%) in the U.S. between 2008 and 2014. Even generic drugs have seen some unwarranted price spikes, as pharma companies acquired old-line medications that no longer have market competition and raised prices by hundreds, even thousands, of percentage points.
We are committed to taking bold actions that bring down the skyrocketing cost of drugs, to ensure all patients can afford to access the treatments and cures they need. We work with payers to drive value by using formulary management to exclude inflated drugs when clinically equivalent alternatives are available, as in Hepatitis C and diabetes care. And we are pioneering the use of indication-based pricing to ensure patients and their plans pay only for the benefit a drug delivers in a particular type of ailment.
Patients and payers alike have limited resources and make tough choices to make ends meet. Deciding whether they can afford life-saving and much-needed medications should never be one of them. Across the pharmacy landscape – from pharma manufacturers, to physician’s offices and into pharmacies – Express Scripts is creating value so our patients can focus solely on reaching the best possible health outcome.
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