The Hartford’s annual study of drug costs provides insights into what drugs are driving costs, and the results a carrier can expect if they work hard at managing drugs. The big insurer enjoyed a reduction (!) in drug costs year-over-year of one percent, driven largely by the demise of the COX-2 drugs and the emergence of generics for Oxycontin and Neurontin.
Heavy-duty pain med Actiq continues to be a big problem for the Hartford, as it is for other payers. Of note, one payer I work with has been able to sharply curtail the use of Actiq through a targeted clinical management program involving physicians doing peer review. And, Actiq is coming off patent next year, which may reduce the price per dose. (but the manufacturer has developed a “new and improved” version that will likely be used as a substitute…)
The Hartford’s results are not surprising. Payers with aggressive, integrated approaches to managing drug costs are experiencing modest increases in drug expenses, while those without a strong focus on managing pharmaceutical expense have been hammered by costs increasing upwards of 15% annually. The Hartford participated in my firm’s third Annual Survey of Prescription Drug Management in Workers Compensation; their results, and the results of several other large payers, helped keep the industry’s overall inflation rate to 10%.
The keys to success? Managing utilization. A strong clinical management approach. The intelligent use of prior authorizations. And a company-wide commitment, backed up by the resources needed to attack the problem.
What does this mean for you?
You too can control drug costs – by focusing on utilization and clinical management.
Aug
18
I find that what you do not address in this blog is the following. I will use Actiq for our example because it is one of the more effective drugs in use that manage’s my wife’s non-cancer related chronic pain.
1. As consumers we did not create the system of inefficiencies and costs that exist. Drug companies and health care providers in conjunction with their respective lobbyists have created this pile of crap system. The evidence is the inefficiencies and degradations we are faced with day to day in managing health issues like chronic pain.
2. If using Actiq for non-cancer pain is unacceptable to companies like UHC – what is the solution – especially when they have pharmacists reviewing medical decisions of qualified doctors. How is that an effective process – especially when it does not in any way shape or form involve the patient.
3. Short sighted thinking often brings short sighted solutions that continue to build on all the inefficiencies and deficiencies of our system today.
4. The issue of managing costs can’t be blamed on patients and their health which is what happens today. There are so few choices when faced with an extreme situation.
With all due respect – you can’t cause the problem and then put patients as the cause or for that matter their doctors who struggle just as we do to provide relief.
Thank you
-Gordon Gabbay
My name is Karen Tobin and i would like to show you my personal experience with Neurontin.
I have taken for 4 months. I am 54 years old. Was taking 1800 mg per day for pain, numbness and scalp soreness. It helped immensely and right now am weaning off of it taking 300mg two times daily with no noticeable side effects.
I have experienced some of these side effects-
Drowsiness and dizziness.
I hope this information will be useful to others,
Karen Tobin