5 Legislative Policies for More Affordable Rx

Apr 3, 2013
Express Scripts' chief medical officer discusses 5 legislative policies that would lower the cost of prescription drugs for Americans.

At Express Scripts, everything we do is built around lowering healthcare costs while improving outcomes. I’m frequently asked about the role government can play in these efforts: Which regulations are effective? Which are counterproductive? And what about the Affordable Care Act?

Well, without going law by law, here are five general policies that we at Express Scripts proudly promote:

1. Continue to Allow the Safe Use of Generic Drugs

Today, 7 in 10 prescriptions filled are for generic drugs, and this trend has resulted in $734 billion in savings to the U.S. healthcare system over the past decade. Required by the FDA to have the same active ingredient, strength, dosage form and route of administration as their brand-name counterparts, generics save patients and plan sponsors more than $90 per prescription and allow patients to remain more adherent with their therapies.

Changing generic drug substitution laws imposes duplicative and medically unnecessary requirements on pharmacists and doctors at the expense of patient outcomes.

2. Do Not Restrict a Patient’s Freedom to Choose Home Delivery

Home-delivery pharmacies are an increasingly important tool used by employers, unions and other plan sponsors to make prescriptions safer, more affordable and more convenient. The use of cutting-edge technology and techniques allows home-delivery pharmacies to achieve 23x greater accuracy than retail pharmacies. Meanwhile, patients using home delivery are 7% more adherent to their therapies, resulting in better health outcomes.

Restrictions on home delivery reduce consumer choices and limit the ability of plan sponsors and employers to design cost-effective prescription-drug benefits.

3. Keep Competitive Data Confidential

Employers and health plans rely on pharmacy benefit managers (PBMs) to make the use of medications more affordable for consumers. Only by maintaining the confidentiality of business contracts are PBMs able to successfully negotiate deep price discounts with manufacturers and pharmacies.

The Federal Trade Commission has warned that legislation requiring disclosure of PBM competitive data would increase costs and “undermine the ability of some consumers to obtain the pharmaceuticals and health insurance they need at a price they can afford.” 

4. Reduce Fraud, Waste and Abuse

Inappropriate billing, prescription-drug shorting, prescription refill errors and illegal remuneration schemes cost Americans millions of dollars each year. Plan sponsors use technically advanced systems to combat increasingly sophisticated fraud schemes. Pharmacy audits that ensure proper payments save plan sponsors and patients money.

When routine audits are restricted, or new standards that require rapid payment are adopted, plan sponsors are forced to “pay and chase” instead of working to prevent fraud in the first place. 

5. Maintain a Plan Sponsor’s Ability to Manage Drug Costs

Prior authorization, step therapy and other clinical protocols in Medicare Part D have helped lower the program’s total expenditures 43% under the original projection. These tools drive waste out of the healthcare system by substituting lower-cost generic and brand drugs when clinically appropriate. Plan sponsors manage their benefits by making sure the right patients receive the right drugs.

Since higher prescription costs often lead to discontinuation of therapy, low-cost medication options ensure better health outcomes.

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