Cost Management Approaches for Expensive Drugs: Page 2 of 2

July 11, 2016

Millions on the Line

They may not be flashy, but these tried-and-true methods can make a big difference to payers and deserve attention. “Sometimes people get so consumed with how rapidly the industry is changing that they overlook the basics. Pharmacy benefits managers need to lead the way in innovation, including performance-based contracting, disease-specific accountability models, predictive analytics, and things of that nature,” said Dr Johnson. 

“But payers, particularly employer groups, need to look at all the traditional tools available to them and start saying ‘yes’ to those because they have been proven to yield savings. And even small savings, compounded over time, add up to millions of dollars.”

The speaker shared with the audience “A Tale of Two Employers.” The employer groups were similar, he explained, except for one big difference: Employer A neglected to institute a complete drug cost management strategy, while Employer B did. The result? Nearly $34 million in excess drug costs shouldered by Employer A. 


Stakes Are Higher

The moral of the story is clear—the time for managing drug costs is now. 

“Prescription medicine is going to become a larger and larger factor in people’s health and in health care spending. There are a lot of new drugs in the pipeline. Some of them may be miracles for people suffering from various types of cancer, multiple sclerosis, and autoimmune diseases. Other drugs may offer marginal, if any, additional benefits,” he said. 

“So as the industry changes, the challenge remains the same: How do we ensure that people who need these medicines have access to them while keeping the cost of coverage affordable? The stakes are getting higher.”

As Dr Johnson reminded the audience, benefit decisions affect the health and well-being of real individuals. 

Rather than issuing a blanket refusal to employees, even those who stand to benefit from a new specialty drug, payers will do better using established tools to ensure their workers are healthy and happy, and that their cost of care is affordable.—Jolynn Tumolo