Drug Benefit News: Highlights / Comments

I just flipped through the February 29, 2008 DBN edition.  A few things caught my eye:

  •  There is a whole article on PBMs and health plans focusing on physicians to manage Rx costs.  [Is this really new news?  The problem is not the focus, but on the incentives, the communications, and the age old question of who is in charge.]
    • As I pointed out in my recent webinar, most physicians agree that out of pocket spend is an issue for patients BUT most of them think it is the pharmacists role AND most of them are upset with the amount of calls they get from the pharmacists [who are trying to manage the spend].

Brian Solow, MD, medical director at Prescription Solutions says
“Physicians in the past have seen PBMs as maybe interfering with the practice [of medicine], but now they understand that [PBMs are] here and here to stay.  We’re trying to get the word out that the PBM is there to maximize the patient’s benefit, which hopefully in turn will make the physician’s life easier by helping the patient control the disease and get the proper medications.”

A physician who they interviewed summed up the confusion well saying:

“You just sort of pick [a drug], hope it flies, and if it doesn’t, somebody has to deal with it.” 

Short of common formularies or working in a captive model (e.g., Kaiser) it will be hard to eliminate the confusion of different plans and different information.  Simplifying processes like Prior Authorizations could help.  Pushing information to the point of prescribing via electronic tools could help, but you are asking the MD to own the benefit management task which they don’t today.  (i.e., let me prescribe drug A…it has $x copay…would you prefer a cheaper alternative)

It talks a lot about the CVS/Caremark settlement which is a lot like the Medco settlement from a few years ago.  The outcome [which is what I think they do today] is that they agree to:

  • Not move people to a more expensive drug (net cost or copay).
  • Not move from a MSB (multi-source brand) to a SSB (single-source brand).
  • Not move away from a drug whose patent is likely to expire in the next 6 months.
  • Inform patients and prescribers of the impact on copayment.  [very difficult]

It also gives the latest on Medicare Part D lives:

The total enrollment is 17.4M (as of January 2008).

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