2009 Drug Trend Insights - Prime Therapeutics

Synchronize Benefits forGreater EfficiencyThe facts: Pharmacy spendingrepresents approximately 10 to20 percent of total health carecosts. 12 And studies stronglysuggest that drug treatment hasthe potential to positively impactother health care costs, such hasphysician fees, hospitalization10, 11, 25, 26expenses and ER use.The difficult question is whetherprescription drug expenses providenet economic value to those whopay for health care. Given thatthere is a proven potential to impacttotal health care spend, the biggestchallenge plan sponsors face ismaking sure that their pharmacydollars purchase the best possibleoutcomes.Five percent of the population accounts fornearly 50 percent of health care costs (fig 35).Given such high utilization and costs, theopportunity to reduce health care expenseis greatest in this group. Preventing at-riskindividuals from moving into a high-use/highcostgroup can help to rein in health care costs.The opportunity: When individualrisk factors are taken intoaccount, pharmacy outreachand adherence programs can betargeted to those individuals mostlikely to incur future medicalcosts. Synchronized medical andpharmacy data provides the mostprecise identification of high riskindividuals, thus maximizing thereturn on pharmacy investmentand helping to ensure a neteconomic value. In addition,targeted outreach has provento be three times more likelyto actually improve adherence. 43What to do: Take advantage ofour coordinated approach topharmacy benefits. When medicaland pharmacy costs are viewedtogether, plan sponsors gain a morecomplete picture of total healthcare spending.Fig 35 concentration of health care spending in the u.s. population, 2006Percentage of total health care spending10080604020top 1%(≥$41,580)top 5%(≥$14,601)top 10%(≥$8,078)top 15%(≥$5,558)top 20%(≥$4,029)Percentage of population, ranked by health care spendingtop 50%(≥$776)Bottom 50%(