502.495.5040

$2.1 Billion in Waste – How Much is Yours?

Aug
07

The huge Pharmacy Benefit Manager (PBM) Express Scripts recently reported that work comp prescription drug waste exceeds $2 Billion per year.  This, they believe, is due primarily to the dispensing of expensive medications when lower-cost equivalents are available.  No mention is made of increased utilization.

Trying to determine the “truth” in the prescription drug industry is mind-boggling. For instance, PBMs would like you to believe they work hard to hold down utilization.  But a PBM only makes money when it sells drugs, so is it reasonable to assume they will work vigorously to NOT sell their product?

And why does the PBM encourage you to switch from name brands to generics?  Often it is because the PBM’s profit margin is greater in the generic product than the name brand. Sometimes you see these cases where the pharmacy makes $1.25 and the PBM makes $15.00. Try to take spread pricing, rebates, dispensing fees, and a bunch of other “fees” and make sense of them.  I dare you!

But if you don’t buy the drug, you don’t need to worry about the pricing. That’s the point of effective pharmacy utilization review.   Time and again the patient should not be receiving the drug in ANY form, generic or otherwise.

We spend many hours each day reviewing a variety of drugs and determining their appropriateness.  Our physicians consult directly with treating physicians to modify or eliminate drug regimens when the clinical need no longer exists. Focusing on clinical guidelines, appropriateness and extent and duration is the path to significant savings.

Call Us.  We can do better.

William V. Faris, JD
Chief Executive Officer
502-495-5040
william.faris@omca.biz
www.omca.biz

Posted in Group Benefits Programs, Medical Cost Containment, Workers’ Compensation