Both employers and employees regularly feel the impact of rising health care and medication costs. On the pharmaceutical side alone, industry changes are happening at a dizzying pace— with multi-million-dollar gene therapies hitting the market, continued drug price increases, and a growing number of costly specialty medications seeking FDA approval each year.
The good news is there are several practical strategies brokers and employers can implement now — even before a new plan year starts— to help lower an organization’s drug spending. Here is a quick overview of three ways to save money:
Review Coding of Specialty Infusion Medications
If plan members are receiving infusions of specialty medications, the medication may be billed with a J‑Code and will land on the medical side of claims. Hospitals and infusion centers often charge up to three times more for specialty medications through the medical benefit compared to the pharmacy plan.
True Rx Health Strategists offers a solution called True Codes. With this service, highly experienced Nurse Navigators trained in specialty medications work with physicians and patients to source the medication through the pharmacy benefit and explore treatment center options. Often, patients find the location, hours, and check-in process at alternative infusion facilities are more convenient.
Match Patients with the Most Effective Medication
If your drug plan doesn’t include pharmacogenomics (PGx), you may be spending more than needed in several large drug categories, including antidepressants, statins, ADHD/ADD medications, and more.
Pharmacogenomics uses a simple cheek swab to determine how an individual patient will process certain medications based on their individual genetics. Health care providers and patients use this information to select the most effective medication the first time, eliminating unwanted side effects and a lengthy period of medication trial and error.
Ask your pharmacy benefits management company (PBM) about pharmacogenomics solutions and best practices for implementing this type of program. Explore how the pharmacogenomics process works through the True Genomics clinical program offered by True Rx Health Strategists.
Explore Options for Biosimilars
A growing number of biosimilars are becoming available as an alternative to expensive biologic drugs used to treat arthritis, psoriasis, cancer, and diabetes. In some cases, adding biosimilars to your formulary can create significant savings.
If you want to explore biosimilars, it’s best to consult with a clinical pharmacist to evaluate the implications for patient care. Biosimilars, though highly similar to their reference biologic drugs, are not identical. A clinical pharmacist can help you assess the potential benefits and drawbacks of specific biosimilar options.
Take Steps to Lower Drug Spending
If you are with an employer, broker, or TPA who would like to discuss strategies to lower drug spending, contact us at firstname.lastname@example.org to schedule a meeting with a True Rx pharmacist and health strategist. If you are an existing True Rx partner or client who would like to explore including one of these options in your existing pharmacy benefit plan, please contact your account manager.