2009 Drug Trend Insights - Prime Therapeutics

Strategic approach to Pharmacy trendsManage Member Choices:Clinical Programs ImproveSafety and Optimize UtilizationClinical programs help to ensuremembers receive the mostappropriate drug therapy at thelowest cost. These programs arebased on proven clinical evidenceand provide supportive tools thateducate and motivate membersto use the most appropriate andlowest-cost drugs.Our clinical programs providevarious levels of interventions thatimprove the quality of care formembers while increasing the valueof the pharmacy benefit.+ Quantity LimitsQuantity limit programs promotesafe and effective drug usethrough restrictions on theamount of medication memberscan receive during a particulardispensing period or for a specificprescription.+ Step TherapyStep therapy programs driveappropriate and cost-effectiveutilization. Built upon nationaltreatment guidelines, theseprograms typically contain costsby encouraging members touse a generic alternative beforecoverage is provided for a secondline,usually more costly brandnamemedication.+ Prior AuthorizationSome medications have a highpotential for misuse, overuseor inappropriate use. Priorauthorization requires theprescriber to obtain approvalbefore a particular drug isdispensed, thus improving safety.This also optimizes utilization,reducing wasteful drug spending.+ Safety Drug AlertThe Safety Drug Alert providesprescribers with timely safetyinformation about the drugsthey prescribe. Based onclinical pharmacotherapy, FDAwarnings, and utilization changes,prescribers with patients who maybe affected by drug withdrawalsand safety concerns are notified.We can also provide directmember outreach to affectedpatients.OUR INSIGHTS20 points — Increase in Insomnia GFR After Step Therapy Clinical programs such as step therapy are a highly effective way to improvethe generic fill rate. For example, a commercial population that implemented a step therapy program for insomnia medications in 2007 reached80 percent GFR by the end of 2008. During the same period, the comparison group’s GFR for insomnia medications leveled off at 60 percent.Among the step therapy groups, ingredient costs per insomnia prescription were $15 less than in the groups without the program. Tremendousadditional savings are possible if generic use is similarly optimized across each of the key Spectrum categories.© Prime Therapeutics 2009 Drug Trend Insights35