Benefits include:
| · | Convenient pharmacy networks |
| · | Screening to prevent dangerous drug interactions and monitoring for inappropriate use |
| · | Drug formularies developed by expert panels of practicing physicians and pharmacists to advise consumers on the most effective drug at the most affordable price |
| · | Generic substitution to lower costs |
| · | Outcome studies to determine the effectiveness of drug treatments |
| · | Home delivery by mail to increase convenience |
| · | Patient education programs, including disease management for chronic illnesses |
| · | Immediate processing of claims online |
| · | Auditing to prevent fraud and abuse |
| · | 24/7 toll free help lines for consumers and pharmacists |
| · | FDA recall notification |
| · | Recruitment, credentialing, training and technical support for pharmacists |
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.
| · Medication errors account for 7,000 deaths annually (“To Err is Human,” Institute of Medicine, 2000). | |
| · Seniors are most at risk for dangerous drug interactions: | |
| ü 51% of seniors visit two or more pharmacies | |
| ü 46% visit three or more doctors | |
| ü 53% use more than five prescription medications | |
| ü 25% of hospital and nursing home admissions among older Americans are the result of improper medication use | |
| · 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. | |
| · 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) | |
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.
| · Prescription drugs are an increasingly important part of effective health care. But increased usage of drugs and new pharmaceutical technologies have increased expenditures. | |
| · 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. | |
| · The economic downturn is putting a strain on state Medicaid programs and could make a Medicare drug benefit less affordable. | |
| · The way to make these drugs more affordable for seniors and all consumers is to allow proven market-based innovations to work. For example: | |
| ü 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. | |
| ü 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. | |
| · State legislative proposals that restrict market competition would reduce the ability of plan sponsors to provide prescription drugs in a cost-effective manner. | |
21st century medicine will demand modern technologies that keep pace with new therapies and the needs of today’s consumers for choice and convenience.
| · 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. |
| · Today’s consumers are looking for pharmaceutical care that is safe, affordable and also more convenient. They want choices, including generics and home delivery. |
| · 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. |
| · Proven market-based innovations will be essential to improving and modernizing Medicare. |
| · 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.
(c) 2002 All rights reserved.