1. Industry Updates February, 2011
The Gardner Group is pleased to present our ninth newsletter. We look forward to continue sharing our experience and timely industry updates.
How to Avoid Medication Variations in Drug Costs
Mistakes 2011 resulted in an increase in the growth of consumer-directed
health plans (CDHP). By the end of 2011, it is expected that
Find out the name of your medication: close to 60% of U.S. employers will offer a CDHP. The increase
may be partially due to Health Reform and the premium hikes
Most of us just pass the prescription from the expected as a future result.
physician to the pharmacy without paying much
attention. To avoid mistakes, write down the drug With this increase comes the need for employers and their
name before you give the prescription to the employees to become familiar with and accountable for their
pharmacy and double check that it matches when own healthcare decisions. Most don’t realize that, in addition
they provide your supply. Do the same with refills to using available generics, comparing costs between
and make sure the medication inside looks the same pharmacies (even those within the same chains) can lead to
as before. significant savings. In one circumstance alone it was
discovered that a popular name brand drug could be purchased
Ask questions about how to use the medication: for $2,500 less annually by switching pharmacies.
Traditionally, insurance professionals have focused on the cost
Choose a physician and pharmacy that you are savings associated with managing high dollar claims such as
comfortable with so you feel free to ask questions. those for in-patient stays. Recently it has been realized that
Some examples – what to do if skip a dose? What side variations in drug costs can add up to significant savings.
effects are possible? Are there activities, food and/or
other medications to avoid? Should this be stored in The future includes readily accessible databases comparing
the refrigerator? pharmacies to each other outside of and within the same
chains. In the meantime, shoppers can utilize the online tools
available through their health insurance providers, keep the
lines of communication open with pharmacies and physicians
and compare the costs at those 2 or 3 pharmacies that are most
convenient for possibly significant savings.
-Employee Benefit Advisor
Know exactly what your medication is meant to do:
Super Bowl Heart Trouble?
According to Dr. Robert A. Kloner, Heart Institute of Good
One physician reported that his patient mistakenly
Samaritan Hospital, physicians and patients should be aware
thought her glaucoma medication was for treating
that stressful games might elicit an emotional response that
headaches, so she was taking her eye medication only
could trigger a cardiac event. And we all thought it was just the
when she had a headache when she should have been
beer and greasy food!
taking it every day!
Surprisingly, the risk association appears to be even stronger
Read the labels and follow directions: for women than men according to the report published online
in the journal, Clinical Cardiology. History reveals that in
Be sure to read the label every time you use your
hometown locales where fans bear witness to the loss of their
medication. In the middle of the night you could
team, there is an identifiable bump in cardiac-related illness.
accidently use the wrong one or overdose yourself or
Historically, in 1980, cardiac illness rose 15% in men and 27
your children. Use the measuring device that comes
percent in women when the Rams lost to the Steelers. By
with the medicine or ask for one from the pharmacy.
contrast, in 1984, the Raiders win was linked to a drop in
cardiac-related issues overall for the Los Angeles area.
Keep your providers informed:
Dr. Shukri David, chief of cardiology at Providence Hospital,
Carry a list of all medications (including over the
calls it the “perfect storm” when the extra excitement for the
counter and vitamins) and provide a copy to any
many viewers who are normally sedentary is combined with
provider you see, including physicians, pharmacists,
the junk food and excess drinking. For those with personal
and/or hospitals. At the very least, put all of your
funds at risk, a disappointing outcome completes the storm. If
medications in a bag when you go to your annual
you can’t keep the game results in perspective, Dr. David
checkup.
recommends a game day plan for the possible results.
Computerized Medication Box:
The FDA has cleared for marketing the Electronic
Medication Management Assistant (EMMA), a
programmable device that stores and dispenses
prescription medication for patients’ use in the home.
This includes two-way communication software that
allows a health care professional to remotely manage
prescriptions stored and released by the patient
operated delivery unit. It emits an alert when
medications are to be taken, releases them onto a
delivery tray when activated by the patient and keeps
a historical record. Until widely available, we must
organize ourselves!
-U.S. Food and Drug Administration

2. Industry Updates February, 2011
Wellness Incentives Survey Trends for Prescription Drug
Results: Plans:
In a survey of over 1,000 organizations, the following The Pharmacy Benefit Management Institute (PBMI) conducted
responses were the result of questions regarding the a survey of U.S. Employers from March 2010 through May
use of incentives in wellness efforts: 2010. The survey was completed by 372 employers
representing 5.8 million members. The survey is meant to
-49% awarded gifts, 47% used raffles or prize collect trends in drug plan design and utilization for retail,
drawings and 49% included discounts and mail-service and specialty pharmacy. Because the specialty
subsidies for preventive health services. pharmacy area is growing rapidly, special attention was paid to
cost control strategies in this area.
-37% subsidized membership for gyms and 32%
did the same for wellness classes. Trends include:
-Employers expect to use 6 times the amount of
technology driven activities within the next three -An increase in the number of cost sharing tiers
years.
-Cost share amounts for preferred and non-preferred
-66% of employers brand drugs are increasing
have a wellness
strategy, a large -Employee cost sharing percentages have remained flat
increase from 49% despite overall cost increases
in 2007. 62% use
incentives. -Pharmacies are being reimbursed at lower percentages
-Although there is -Utilization Management efforts are increasing to curb cost
a trend of rewarding and inappropriate utilization
when specific health
goals are met, most rewards are typically for -As brand name drugs lose patents an increase in generic
participation in health screenings or educational and over the counter options
activities.
Below is an illustration of the comparison of employee drug
-A lack of physical activity was cited as the top expenditures as a percentage of total claim costs:
driver for including wellness programs in the
workplace. 30%
Average Annual
-Working Well: A Global Survey of Health Percentage Increase
Promotion and Workplace Wellness Strategies 25% in Prescription Drug
Expenditures
We are now on Facebook! 20% Retail Pharmacy
Claim Costs Paid by
Beneficiary
As another means of communicating and keeping our 15%
clients informed we created a Facebook page. We will
be posting our Industry Update Newsletter, Health Mail-Service
Tips, Healthcare Reform Newsletter and much more. 10% Pharmacy Claim
Come visit us by clicking anywhere on this newsletter. Costs Paid by
Beneficiary
5%
Specialty Pharmacy
Claim Costs Paid by
0% Beneficiary
2006 2007 2008 2009 2010
2010 key findings include that about 48% have introduced
value-based plan design tools in their drug benefit plans. 96%
offer mail-service pharmacy for maintenance medication. 19%
require mail-order for maintenance medications to control
costs. 82% offer specialty pharmacy drug coverage, but there is
a change to how these specialty drugs are dispensed in 2010
from previous years (consolidation of vendors). Participants
pay a much smaller percentage of total cost for specialty drugs
than retail or mail order.
The most commonly used utilization management tools are
refill too soon (89%), quantity limits (88%) and prior
authorization (77%). The average rate of drug cost increases
was 6%, an increase over last year of 4%. The health care
industry is facing some of the largest changes in history and it
will be important that all parties work together to determine the
best drugs at the best time from the best source in order to keep
this important benefit financially possible.
-Pharmacy Benefit Management Institute