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Prescription
drug benefits provided by employers and unions through their health
plans account for 70 percent of the 3.2 billion prescriptions filled
each year—helping more than 170 million Americans receive better
health care.
Benefits
include:
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Convenient
pharmacy networks |
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Screening
to prevent dangerous drug interactions and monitoring for inappropriate
use |
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Drug formularies
developed by expert panels of practicing physicians and pharmacists
to advise consumers on the most effective drug at the most affordable
price |
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Generic
substitution to lower costs |
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Outcome
studies to determine the effectiveness of drug treatments |
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Home
delivery by mail to increase convenience |
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Patient
education programs, including disease management for chronic illnesses |
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Immediate
processing of claims online |
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Auditing
to prevent fraud and abuse |
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24/7
toll free help lines for consumers and pharmacists |
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FDA
recall notification |
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Recruitment,
credentialing, training and technical support for pharmacists |
Safety
Prescription drugs have
become an increasingly important part of effective health care. As the
use of prescription drugs grows and drug therapies become more complex,
there is a vital need for information and services that help doctors
and pharmacists protect consumers against dangerous drug interactions
and medication errors, leading to safer health care.
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Medication
errors account for 7,000 deaths annually (“To Err is Human,”
Institute of Medicine, 2000). |
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Seniors
are most at risk for dangerous drug interactions: |
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51% of
seniors visit two or more pharmacies |
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46% visit
three or more doctors |
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53% use
more than five prescription medications |
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25% of
hospital and nursing home admissions among older Americans are the
result of improper medication use |
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Systems
that allow pharmacists and physicians to screen for dangerous drug
interactions protect consumers—especially seniors—and
gives them freedom of choice by allowing them to visit different
doctors and pharmacies and still be protected. |
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The Government
agrees on the need for these services: |
| “These systems identify instances in which
a drug may be inappropriate for a patient given a person’s
medication or age. …Such interventions can both improve quality
of care and prevent additional health care costs by reducing drug
interactions or flagging evidence of inappropriate use, such as
early refills.” (GAO Testimony before U.S. Senate Finance
Committee March 22, 2001) |
Affordability
Proven market-based innovations are the best
way to reduce the rising cost of Rx drugs. They provide a better way
to control costs than government price controls, which limit the supply
and development of new drugs. These innovations will help make a Medicare
prescription drug benefit affordable.
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Prescription drugs are an increasingly important part
of effective health care. But increased usage of drugs and new
pharmaceutical technologies have increased expenditures. |
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Most elderly Americans pay for a portion of their
drugs out of their own pocket and nearly a third pay for all of
their drugs costs. |
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The economic downturn is putting a strain on state
Medicaid programs and could make a Medicare drug benefit less affordable.
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The way to make these drugs more affordable for seniors
and all consumers is to allow proven market-based innovations to
work. For example: |
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PBMs contribute
an average of 20 to 30% reduction in payers’ costs (Credit
Suisse First Boston report January 2, 2002) through such strategies
as bulk purchasing, manufacturer and pharmacy discounts, and other
cost efficiencies, including home delivery services. |
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The state of Georgia contracted with a pharmaceutical
benefit manager, Express Scripts, to comprehensively manage pharmacy
benefits for the beneficiaries of the state government health care
program. In the first year of the program, annual Medicaid drug
spending dropped from 26% to 17%, saving the state millions of dollars.
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State legislative proposals that restrict market competition
would reduce the ability of plan sponsors to provide prescription
drugs in a cost-effective manner. |
Innovation
21st
century medicine will demand modern technologies that keep pace with
new therapies and the needs of today’s consumers for choice and
convenience.
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More complex
and potentially more costly drug therapies are on the way, increasing
the need for physicians and pharmacists to have the necessary data
to prevent harmful drug interactions and monitor correct patient
use. |
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Today’s consumers are looking for pharmaceutical
care that is safe, affordable and also more convenient. They want
choices, including generics and home delivery. |
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Home delivery is growing. It’s the fastest growing
segment of prescription drug delivery, as more and more people turn
to the convenience of ordering drugs by phone, fax or the Internet.
87% of large employers offer this benefit, and customer satisfaction
rates are high. |
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Proven
market-based innovations will be essential to improving and modernizing
Medicare. |
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Government
should foster innovation and competition in the delivery of pharmaceuticals,
not impose regulations that stifle innovation and freeze in place
outdated practices and artificially high prices. |
The Rx
Benefits Coalition represents a diverse group of employers and other
payers and providers of prescription drug benefits committed to ensuring
that consumers have access to safe and affordable prescription drug
services through the use of proven market-based innovations in pharmaceutical
care.
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