February 24, 2010 
The list of PBMs producing drug trend reports continues to grow with InformedRx entering the research publication area. Now we have Express Scripts, Medco, CVS Caremark, Walgreens, and Prime Therapeutics.
- Their book-of-business trend for 2007 and 2008 was 0.5% PMPY.
- Their GDR was 69% (a 7.8% increase over the prior year).
- Their non-specialty trend was -0.5% in 2008. [This makes me wonder if they had become more aggressive on plan designs in that period to drive negative trend.]
- Their specialty trend was 9.6%.
- They have a list of options to mitigate drug trend. I was pleasantly surprised to see the first one was preferred or restricted retail network arrangements. (The 3rd thing was targeted member communications.)
- Their costs per Rx were: (not sure if this is AWP, client billed amount, or something else)
- Total – $52.47
- Brand – $110.82
- Generic – $18.09
- Their utilization trend was 0.3%.
- They have a brief therapeutic class section on the top 5 classes.
- 80% of the new chemical entities that are expected to reach the market in the new year will fall in the specialty category.
- They state that the goal on 4th tier (specialty) and 5th tier (life style and cosmetic) is the have an equal cost share between clients and members. [I’m not sure I understand if this means to continue the same percentage cost share or to split the costs 50/50 on that tier.]
- They mention that an approach to use is pplacing DAW penalties in place. [I can’t believe that companies don’t have this in place today…shame on an account manager who hasn’t convinced their client of the logic of this.]
- I’m a little confusioned on pg. 25 when they talk about adherence and drug cost savings. I thought that costs would go up on the pharmacy side but produce savings on the medical side.
- I was also surprised to see that they were recommending a mail copay for 90-days equal to two 30-day retail copays. I thought that this had to be closer to 2.5 retail copays to make sure the client saved money.
Overall, I think it’s a good first document. It reads easily, but I think it needs more primary research. I also think the forecast at the end has to be a little more visionary.
Enabling Healthy Decisions 
Ron – interesting point. I hadn’t thought of it in that way. I certainly know that physicians often may see a lab value that shows that a drug is “not working” and step a patient up to a different drug or higher dose when the real issue is adherence.
Patients often start on generic drugs then switch to brands due to a “failure”. The failure is usually due to non-adherence. Increased adherence keeps patients on generic medications for a longer period, thereby lowering cost despite higher adherence. It took me a few years to figure that out while puzzling over the results of our adherence programs.