In today’s economy, we are all looking for ways to save. And, it should be no surprise that pharmacy is the most frequently used benefit since, on average, people get fourteen 30-day prescriptions per year.
That being said, there are still hundreds of dollars that millions of us can save. Let’s take an easy example – Lipitor. Lipitor still has about $8B in sales here in the US. If you assume the monthly cost is $125 per 30-day supply and everyone on the drug filled it 12 times per year (which doesn’t happen but is a topic for another day), that means that each consumer on Lipitor represents $1,500 in revenue to Pfizer per year. Dividing the $8B by $1,500 tells me that there are about 5.3M consumers using Lipitor in the US.
On most formularies (or preferred drug lists), Lipitor is a 3rd tier drug meaning that consumers are paying $40-$50 per month for this drug. Considering the fact that Lipitor has a generic alternative which is called simvastatin (aka generic Zocor), consumers can often talk to their physician and use this drug as a lower cost alternative. Additionally, both of these drugs are maintenance drugs that can be filled at mail order which often represents a 30% savings to a consumer (based on average plan designs). And, finally, simvastatin is a drug which can be split according to many different companies.
Here is the math, but a consumer on Lipitor could talk to their physician to get started on simvastatin, split the pills, and after a few months move to mail. That would save them $400+ in many cases.
- Assuming Lipitor is a 3rd tier drug with a $40-$50 monthly copay and the consumer fills the drug every month for a year, they would spend $480-$600 out-of-pocket.
- Assuming they moved to simvastatin (with their MD’s approval) with a $10 copay, they would immediately drop their costs to $120.
- Assuming they split their pills (i.e., got a higher dose of the medication and used a pill splitter to use ½ the pill each day), they would typically reduce their copays by 50% or drop their costs to $60 a year.
- And, if they then moved the prescription to mail where they reduced a 90-day supply for the same price as a 60-day supply at retail, they would drop their out-of-pocket costs to $40 a year.
I don’t know about you, but that seems pretty easy. It’s clinically appropriate for most patients. The PBMs will typically help you with these programs by reaching out to your physician to get the new prescription.
Hopefully, you’ll be hearing from your PBM or managed care company about these savings. At Silverlink Communications, we are working with lots of them to design and execute these types of programs. It is always very rewarding to get in touch with consumers and bring them a message about how to save money.
If you are a health plan whose premiums are going up, this is a great way to reach out to your membership and provide them with a positive message about how you care and are responding to them in these tough economic times.
March 13, 2009 
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[As I have disclosed before, I do not hold any individual stocks.]
Imagine that every year for open enrollment you would simply create a file of all your claims from the prior 12 months and upload them at some website “TestMyHealthInsurance.com”. That website would show your employer sponsored options along with individual insurance options and show you what your total out of pocket costs would be under each scenario (assuming the same claims).
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