Drug Trends
  • Current trends increasing ~6% (IMS reports 8.3% overall for 2006), normally drug trends increase 15% – 20%; new generic drug introductions have mitigated this trend
  • Health Care Costs 101 for 2007, from the California HealthCare Foundation, does a great job of dissecting and presenting trends for the various components of health care
  • Over six years, new drug introductions account for approximately 2/3 of price (see AWP litigation info) and utilization increases; better evaluation of new drug launches lead to effective trend management approaches
  • Specialty Drugs will add to the cost burden and have a pharmacy trend approaching 30% (IMS reports 20% overall for 2006, see link in first item)
  • A primary focus on unit cost (e.g., PBM Deals) ignores the major drivers of cost and poor quality; this Medicaid analysis provides a good example
  • Benefit design can help control costs, but may have unintended consequences
  • Drug sampling drives more utilization than direct-to-consumer advertising (DTCA)
  • Changes in treatment rates for chronic medical conditions are contributing to increased utilization
    • 80 – 100 new drugs, new dosage forms, and new indications await FDA approval
  • Rx to OTC conversions and patent expirations will help control trend
    • Your focus should be on increasing generic use, not Rebates
    • Drugs with sales of $30 billion could loose patent protection over the next three years
  • Minimizing drug therapy problems likely provides the greatest savings in health care costs

Managing Pharmacy Benefits Checklist

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