The Express Scripts Outcomes Conference

In my time at Express Scripts, one of the most interesting events was our Outcomes conference. We invited about 700 clients to come to beautiful St. Louis for 3 days to hear from our research group on trends and new programs to manage pharmacy benefits. All the large PBMs (Medco, Caremark, Express Scripts) put out annual publications on their research.

Express Scripts puts the publication along with the slides and audio out on the Internet. Here is a quick summary from 2007 which I took from the website.

• Brand prices rose 6.9% in 2006, while generic prices fell 5.7%, which shows how generics continue to play a major role in managing prescription-drug trend.
• 2006 drug trend of 5.9% – lowest in a decade.
• More than $50 billion worth of brand drugs are scheduled to lose patent during the next five years. Important examples include Prevacid^® in 2009 and Lipitor^® in 2010.
• Twenty percent of drug spend comes from specialty medications, but relatively few people use these types of drugs. This portion is projected to grow to 26% by 2010.
• There are over 600 biopharmaceuticals products in the pipeline. This trend is being driven by the Human Genome Project, breakthroughs in the field of biopharmaceuticals, and a philosophical change in the pharmacy industry.
• A growing number of members are becoming engaged in their decisions about prescription drugs, seeking information on drug-therapy alternatives and the prices of these alternatives. For example, 21% of the users on Express Scripts’ website used the Price Check feature during Q4 2006.
• What Patients Don’t Know About Their Prescription-Drug Benefit
  • 64% could not correctly identify the type of pharmacy benefit plan they enrolled in.
  • 60% could not correctly identify the amount of their generic copayment.
  • 50% indicated their physician or pharmacist never or seldom talked to them about generics.
• Several active ingredients work to influence the effectiveness of the information that plan sponsors provide to members:
  • Opportunity – Making sure you provide the information at the time in which the member is most engaged in the decision-making process.
  • Incentive – Members sometimes need an additional short-time incentive to choose the lower-cost option.
  • Assistance – Changing medications requires considerable assistance, which provides a barrier in making this adjustment.
• The hypothesis was that Part D beneficiaries would take advantage of lower-cost generics to avoid hitting the donut hole. However, the reality is that many beneficiaries are hitting the donut hole unnecessarily and could take advantage of lower-cost generics.
• Express Scripts’ research has shown that there is a direct correlation between a higher generic fill rate and the lower percentage of members reaching the donut hole.
• The hypothesis from Wal-Mart was that low prices on selected generics would result in more volume of other generics and brands as well as increased nonpharmacy store sales. However, their market share increased by just 1% overall, which lead to a minimal market impact on prescription-drug use. Three reasons for this minor effect:
  • Members didn’t always save as much as advertised, and the payment was closer to $6 due to program limitations.
  • Members did not want to unbundle their prescriptions and use multiple pharmacies.
  • Many patients do not consider Wal-Mart a convenient choice.