7 Healthcare Storylines for 2015

Dec 31, 2014
Seven key moments of 2014 foreshadow what will be driving the pharmacy benefit conversation in 2015.

As 2014 ends, we’ve taken a look back on the most significant storylines. These seven topics changed the pharmacy benefit landscape and will certainly drive the conversation in 2015:

7. Providing the Industry’s First Look at Public Exchanges Enrollees

As individuals enrolled in the Affordable Care Act’s public exchanges earlier this year, key questions existed about these patients’ health, their demographic makeup and their overall healthcare literacy. Using our robust dataset of pharmacy claims – processed months before medical claims – we provided the nation’s earliest indication of who these patients were and how they were using their benefit.

Our Exchange Pulse ReportsTM show that Americans enrolled in the exchanges are using their pharmacy benefit, more likely to use generic medications and filling more prescriptions for specialty medication.

We expect this trend to continue. Given the increased prevalence of specialty conditions, it’s vitally important for these exchange plans to provide patients with clinical programs that ensure appropriate management of complex, high-cost medications.

Enrollees in an exchange plan with a pharmacy benefit administered by Express Scripts have access to specialist pharmacists who can help these patients optimize their prescription therapy and get the most from their benefit, leading to better health outcomes and reduced costs.

Notable media coverage: The New York Times and The Associated Press.

6. Turning Attention to ADHD

Our comprehensive report on U.S. ADHD medication utilization sparked a national discussion and spurred Louisiana’s Department of Health to work with various leaders to address proper utilization rates in the state.

According to our pharmacy claims data, the number of Americans who use medication to treat ADHD rose 36% from 2008 to 2012.

Most surprisingly, we saw the greatest increase in use during the five-year study period was among adults, with the largest gains seen in women ages 26 to 34, climbing 85%.

Notable media coverage: NBC News and NPR.

5. Examining a Nation in Pain

Knowing the potential for misuse of prescription opioids, we wanted a deeper understanding of how patients in the U.S. are using these medications so that we would be able to protect these patients from the risks associated with their use.

In A Nation in Pain, our research revealed that although the percentage of Americans taking opioids is decreasing, those patients are taking larger doses than ever. More concerning, nearly 3 out of 5 patients on long-term opioids are taking potentially fatal drug combinations.

Fortunately, our programs to help curb potential safety concerns are working. Research showed 23% fewer patients who filled their medication through the Express Scripts Pharmacy were using a potentially dangerous combination of medications, and 15% fewer patients were prescribed medications by multiple prescribers. Further, the rate of concurrent use of potentially dangerous medications was 7.6% less in patients whose benefit plan was enrolled in the Express Scripts Fraud, Waste and Abuse program in 2013 compared to patients whose benefit plan was not enrolled in the program.

Notable media coverage: Time and CBS News.

4. Making a Case for Biosimilars

For years, we have advocated for a simple process to ensure safe, affordable medications reach patients who need them. Biosimilars will revolutionize the biotech market in the same way generic drugs did for traditional pills more than a decade ago.

The first two biosimilar medication applications are now being reviewed by the FDA and, if approved, could save America $22.7 billion over the next 10 years.

Notable media coverage: PBS NewsHour and The Wall Street Journal.

3. Removing Wasteful Spending of Compounded Medications

From 2012 to 2013, U.S. spending on compounded medications increased 218%. Nobody can afford that sort of annual price hike. Moreover, the safety and efficacy of these medications – which do not receive FDA review and approval – can post serious health risks for patients.

Express Scripts’ comprehensive compound management solution reins in costs while ensuring patients have access to the medications they truly need. By continuously monitoring for clinically unproven compound ingredients, the solution has eliminated 95% of spending on compounded medications with minimal patient impact.

Notable media coverage: The Wall Street Journal and The New York Times.

2. Delivering Smart Formulary Management

Today, many therapy classes have more drug choices than ever, with many prescription drugs costing more but delivering no additional health benefit. One of the ways we keep costs down for patients and payers is by managing the formulary. Our willingness to exclude a handful of “me-too” products from our formulary gave us the leverage to negotiate more effectively with manufacturers and ultimately achieve lower drug prices for the clients and patients we serve.

In the rare instances when patients have a medical need for an off-formulary drug, we have a pathway for that patient to have the excluded drug covered.

This rational approach to formulary management is poised to deliver more than $1 billion of savings for our clients in 2015.

Notable media coverage: Reuters and The New York Times.

1. Achieving Fair Drug Pricing

The cost burden of treating patients with hepatitis C could bankrupt many of the nation’s businesses. Never before had a class of medication been priced this high to treat a patient population this large. Clients and patients needed someone to step up, so we did.

Last week, we announced an update to our National Preferred Formulary that will significantly expand access to AbbVie’s new medication, Viekira Pak®, a breakthrough treatment for hepatitis C. The cost to cure is now low enough that we can treat all hepatitis C patients who have genotype 1, not just the sickest patients.

Our formulary approach makes specialty medications more affordable, and Accredo’s unique clinical model will enable as many patients as possible to be cured of hepatitis C.

Notable media coverage: Bloomberg and The Washington Post.

At Express Scripts, we’re committed to leading the charge on behalf of clients and patients to make the use of prescription medications safer and more affordable. It is through initiatives like these that we align our interests to best serve you.

Wishing you a happy and healthy New Year!

Author Bio

Lab Staff
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