Many people are discussing the challenges of rising drug costs and attempting to not only identify the cause but also a solution. Many consultants and organizations have published extensively on the complexity of drug pricing, which is incredibly important when developing drug pricing solutions.
However, one perspective may be commonly overlooked when addressing drug spend…
Obtaining the best price on the wrong drug is not the best price.
In other words, many consultants are focused on ensuring that pharmacy benefit plans are providing the best pricing but missing the importance of making sure that the preferred drug list on the plan prioritizes optimal drug therapy. This is accomplished by taking in to account clinical evidence, economic data, dosage forms, outcomes, and adherence considerations. If a low cost drug results in increased physician visits or lab costs, it is not really a low cost drug. However, if a high cost drug is prioritized over equally effective lower cost options, the best price on the high cost drug is still resulting in unnecessary high drug costs. Some drugs may need to be removed from a plan’s preferred drug list to reduce costs.
Solution
Rather than prioritize drug pricing, discounts, and rebates; focus on optimizing the preferred drug list and utilization management programs… and then consider pricing, discounts and rebates. At the end of the day, an appropriately trained pharmacist can save a health plan a significant amount of money while improving patient/member clinical outcomes.