Pharmaceutical News: PMSI report sees reversal of three-year trend on pharmacy spend

PMSI report sees reversal of three-year trend on pharmacy spend

The company’s 2011 Annual Drug Trends Report shows decreases in pharmacy costs and utilization based on an analysis of 5.4 million retail and mail-order transactions between 2008 and 2010. The overall 2.3 percent drop in the average spend per injured worker was driven by reductions in both the average cost per day of supply and the average days of supply per injured worker.

“The average cost per day of supply is an indicator of overall drug product cost,” said Maria Sciame, PMSI’s executive director of clinical services. “Another, more familiar term for this indicator is drug price.” PMSI’s report showed that the average cost per day of supply decreased by 2 percent. Additionally, the average days of supply per injured worker dropped by 0.3 percent.

“The average days of supply per injured worker is a measurement of utilization that may be usedinstead of the number of prescriptions per injured worker,” Sciame said. “We found that the average days of supply per injured worker accounts for utilization changes associated with mail-order pharmacy transactions more effectively since the quantity of medication associated with retail and mail-order prescriptions may differ significantly. It could be the difference between a 30-day retail supply of medication versus a 90-day mail-order supply.”

PMSI also credits its improved mail-order penetration rate, a 2.8 percent increase to 29.3 percent, as one reason for the overall decrease in pharmacy spend. The average mail order cost per day of supply in 2010 was approximately 19 percent less than the average retail cost per day of supply.

Another major factor contributing to the improved results was the unusually small increase in the average wholesale price, which Sciame likens to the sticker price of a medication. The year 2010 was the first full year following the average wholesale price adjustment for hundreds of National Drug Codes, as a result of a class action settlement involving two major publishers of drug pricing information.

“In previous years, average wholesale price increased between 8 and 10 percent,” Sciame said. “After the rollback, we measured an increase of only 3.5 percent. This small increase certainly had an impact on overall prescription cost.”

Finally, a focus on less-expensive medications combined with comprehensive utilization control initiatives helped push down overall pharmacy spend. “We were really successful in our ability to impact brand to generic mix,” Sciame said.

According to the report, generic dispensing, the percentage of all prescriptions dispensed that are generic, increased by 3.5 percent. Generic efficiency, the percentage of generics dispensed when a generic formulation is available, increased by 0.7 percent.

“Since we were able to drive the use of less-expensive drugs, overall prescription costs went down,” Sciame said. “This, combined with the utilization decrease associated with our MedAssess clinical program, tipped the scales in favor of an overall spend decrease.”

CVS Caremark to introduce pilot ePA

CVS Caremark, a pharmacy care provider in the US with integrated offerings across the entire spectrum of pharmacy care, is set to unveil a pilot of a real-time, integrated electronic prior authorization (ePA) capability for its CVS Caremark Pharmacy Benefit Management (PBM) clients.

The CVS Caremark ePA pilot will help the company’s PBM clients in improving patients’ experience and speed access to prescription medications.

It will also enable prescribers for coordinating a real-time ePA request when initiating a prescription for a patient.

CVS Caremark chief medical officer Troyen Brennan said the prior authorization process is currently evolving to keep pace as prescribers transition towards electronic prescribing and electronic patient records to better manage their patients’ pharmacy care.

“This pilot is an important step toward demonstrating how the industry can integrate ePA with e-prescribing to streamline and speed up processing of prior authorizations to ensure that members have quick access to care that is medically appropriate and cost-effective,” Brennan said.

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