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.