A featured speaker at several of this year’s MedBen University sessions is pharmaceutical consultant Allan Zaenger, President of Pharmaceutical Horizons. At recent roundtables, Zaenger outlined plan design options employers should consider to reduce prescription costs – among them, the “Cost Plus” pricing approach now available through MedBen Rx Advocate.
Unlike traditional prescription plans that take an inflated average wholesale price (AWP) and take discounts from there to get to the allowed prescription drug price, MedBen Rx Advocate pays the pharmacy based on the acquisition cost index (ACI) plus a set dispensing fee that fairly compensates the pharmacy’s services for filling a prescription.
“The ACI takes the prices network pharmacies pay to acquire a medicine and collects these drug prices into an index that is refreshed every 24 hours,” Zaenger said. “On average, the ‘cost plus’ difference will save the employer 4-6% across all plan prescriptions.”
Zaenger also cautioned employers against the practice allowing plan members to buy 90-day supplies of high-cost specialty medicines. To demonstrate his point, he passed around an actual unused portion of a 90-day supply of the multiple sclerosis drug Tecfidera, which cost the employer $30,000… but because the prescription changed and the patient no longer used this drug, the unopened bottles of this medicine cannot be reused under state law, so “this $30,000 drug will get put in a paint can and destroyed,” Zaenger noted. “That’s an expensive lesson in why specialty drugs should only be bought in 30-day supplies.”
Many expensive brand prescription medicines can also be defined as discretionary or elective drugs. Because of the high costs of the brand name medicines in certain drug classes and the general availability of lower-cost alternatives, Zaenger recommended that the plan member be responsible for 100% of the claim charge after the discount is applied.
“Additionally, brand name medicines in the discretionary classes would not count toward the accumulation of the out-of-pocket maximum,” Zaenger said. MedBen can provide discretionary drug class lists to clients interested in promoting more cost-effective drug usage.
Zaenger will be among the featured speakers at the MedBen Annual Employer Benefits Roundtable to be held in April. For additional information about MedBen Rx Advocate and the “cost plus” difference, contact MedBen Vice President of Sales & Marketing Brian Fargus at bfargus@medben.com.