Generating Savings for Patients and Payers through Improved Generic Prescribing

 
 

Providing actionable information on generics options to physicians using Formulary and Benefit (F&B) data creates significant savings for payers, employers, and consumers.

Physicians have been conditioned to prescribe generics as part of first-line therapies to save patients money and eliminate callbacks requesting prescription changes. But not all generic prescribing is equal. Some forms and strengths may cost significantly more than equivalent alternatives.

Without access to actionable information, physicians are locking patients into more expensive formulations. This results in higher costs for all stakeholders: patients, payers and employer sponsors.

Savings on Generics for Health Plans and Employers

Communicating better information to physicians empowers them to prescribe the best medication for their patients. This leads to savings for all stakeholders.

Payers can address generic cost discrepancies by providing physicians with better cost information at the point of prescribing. Communicating enhanced formulary data or real-time benefit information can guide prescription decisions when multiple generic options, forms, and strengths are available.

Physicians with access to actionable information, no matter the mechanism used to communicate it, are better equipped to select the best option for their patients’ medical and financial needs.

In addition to savings, enhanced formulary data can reduce the time pharmacies and physicians waste on callbacks for prescription changes.

Examples of Generic Outliers by Cost

BenMedica’s analysis of the National Average Drug Acquisition Cost (NADAC) within the generics market revealed significant savings opportunities for health plans and other stakeholders.

Physicians may not be aware that different generic strengths and forms can cost much more than equivalent alternatives. By offering them the right information, payers can reduce prescription costs.

Here are a few examples of the savings available among generic prescriptions.

Cost Outlier by Strength: Duloxetine

For some generics, different dosages cost significantly more than others. For instance, the average price of one 20 mg capsule of duloxetine is $0.19, one 30mg or 60mg capsule is $0.17, but one 40mg capsule costs $2.98.

 
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Access to this information could enable a prescriber to make an informed choice, like prescribing two 20mg capsules instead of one 40mg capsule, saving $78 per month.

Cost Outlier by Form: Venlafaxine

Another example of a generic cost outlier is venlafaxine, which is available as extended release capsules and extended release tablets. The cost per extended release capsule ranges from $0.12 to $0.18. However, extended release tablets start at $4.10 and go up to $10.03 each.

Physicians can save as much as $140 a month by prescribing extended release capsules instead of extended release tablets.

There may also be a way to save money and achieve the same therapeutic effect by prescribing a combination of lower strength tablets instead of one higher strength dose.

 
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Cost Outlier by Form and Strength: Fluoxetine

Another generic where prices vary significantly is fluoxetine. With fluoxetine, pricing diverges among both form and strength options.

For capsules, the average price ranges from $0.03 to $0.10 each based on strength. Tablets cost more: $0.55 for a 10mg tablet, $0.62 for a 20mg tablet, and a whopping $5.76 for a 60mg tablet.

By prescribing three 20mg tablets instead of one 60mg tablet, physicians can save roughly $117 a month. Physicians can also reduce drug costs by prescribing capsules instead of tablets where clinically appropriate.

 
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How BenMedica Helps

BenMedica helps health plans and employers save on prescription spending by enhancing formulary data and communicating actionable information to physicians within their Electronic Health Records. When physicians can see information such as cost and equivalent alternatives, they can select prescriptions that their patients can afford.

We can quickly and efficiently help health plans, employer-sponsored plans, and other payers identify savings opportunities and develop strategies for effectively communicating with physicians.

Learn more about our process or contact us to begin saving on prescription spending today.