Controlling Prescription Drug Expenditures -- MEDICA - World Forum for Medicine

Four health plan interventions not only averted increases in prescription drug spending but also preserved members’ use of medications for chronic conditions, according to the study.

“One reason for this success may be that the plan was careful to avoid shifting costs to its members,” said lead author David P. Miller, M.D., assistant professor in the Section of General Internal Medicine at Wake Forest University School of Medicine. “Whenever a drug was changed to a more expensive tier or removed from the formulary, the members’ out-of-pocket costs were the same or less if they changed to the less-expensive alternative.”

The interventions included reclassifying select brand-name drugs to non-preferred status (resulting in approximately half of the annual savings), followed by (in descending order of savings) the removal of non-sedating antihistamines from the prescription-drug formulary, the introduction of pill-splitting, and the limitation of quantities of select medications not intended for daily use.

The health plan’s goal, according to the study’s authors, was to control prescription drug spending while preserving high quality medical care. An advisory outpatient prescription drug committee, which included physicians and pharmacists, was formed to review the literature and ensure that proposed strategies wouldn’t have a negative impact on health care quality.

The study’s authors wrote that preventing the rise of prescription drug costs allowed the health plan to invest in new initiatives to improve the health outcomes of patients with chronic disease, such as reducing the co-payments for insulin and diabetic testing supplies to encourage medication adherence and monitoring.; Source: Wake Forest University Baptist Medical Center