If you’ve glanced at the headlines lately, you’ve probably noticed that prescription drug prices are trending upward,* and don’t show too many signs of changing course.
Nearly 49 percent of people in the United States used at least one drug in the past 30 days, and more than 11 percent report using five or more according to the Centers for Disease Control and Prevention
Though “bending the trend” of pharmacy involves many different components, Wellmark Blue Cross and Blue Shield is able to positively influence the Wellmark Drug List Opens in a new window, which is one piece toward creating a sustainable health care system. To do this, Wellmark evaluates drugs based not just on total cost, but rather the drug’s true value.
A drug’s true value takes into account safety, effectiveness, and relative cost when assigning a drug to a specific level or tier within the Wellmark Drug List. Consider two common prescription drugs that treat diabetes. Metformin and Glumetza® are both safe and high-performing when evaluated for controlling blood sugar and the prevention of diabetes. However, metformin costs much less when compared to the other drug options. In this instance, metformin is a best buy and your best bet.
Here's an example of how a drug's value may be determined. The drugs here include metformin, glimepiride, Januvia®, Farxiga® and Glumetza. When it comes to blood sugar control, metformin, glimepiride and Glumetza score well. Januvia and Farxiga do not. On the metric of prevents diabetes, metformin and Glumetza score well, while glimepiride, Januvia and Farxiga do not. On the metric of no safety concerns, metformin, Januvia and Glumetza score well, while glimepiride and Farxiga do not. Finally, when looking at the metric of total cost, metformin is the least expensive, followed by glimepiride, Januvia, Farxiga and Glumetza. Based on this scoring, metformin is the most effective and lowest cost medication.
By emphasizing these three criteria — safety, effectiveness and relative cost — we’re able to better protect your employees’ health in the long run. It’s part of Wellmark’s commitment to make the right choice the easy choice.
Learn more about the different ways you can personalize your pharmacy benefits program in order to best serve your employees and your organization’s bottom line:
- Understanding pharmacy costs to create a sustainable future
- Decision-making with the Pharmacy & Therapeutics Committee
- Using utilization management to improve health
*While these high prices are usually linked to brand-name or specialty drugs, they do influence the overall trend of health care spending.