At What Cost: 6 Financially Wasteful Medications

The skyrocketing cost of prescription medications inflicts a financial burden on everyone in the healthcare realm – from consumer to plan sponsor. Controlling these costs by reducing drug spend and lowering out-of-pocket costs for members is a priority and necessity for pharmacy benefit plan sponsors. One way to reduce spend under the pharmacy benefit is identifying high-dollar prescription medications that have lower-cost prescription or over-the-counter (OTC) alternatives that are clinically sound, economic alternatives.

At RxBenefits, we have identified six financially wasteful and non-essential prescription medications for which you should avoid paying. These medications, while they contain useful active ingredients, are expensive compared to clinically equivalent alternatives. Avoiding these budget-busting medications will help you avoid high prescription benefit costs for you and your members. It’s a win-win scenario with little disruption to your members’ access to medications for their conditions.

Top three non-essential medications in terms of plan cost per claim:

  1. GLUMETZA
    • Use: Type 2 Diabetes
      • Brand Cost: ~$2,600 for a typical 30-day supply
      • Prescription Alternative Cost: ~$4.00 for a typical 30-day supply
  2. RAYOS
    • Use: Anti-inflammatory or immunosuppressive agent
      • Brand Cost: $2,400 for a typical 30-day supply
      • Prescription Alternative Cost: ~$4.00 for a typical 30-day supply
  3. METFORMIN HCL Extended Release (MOD)
    • Use: Type 2 Diabetes
      • High-Cost Generic: ~$800 for a 30-day supply
      • Prescription Alternative Cost: ~$4.00 for a typical 30-day supply

Top three non-essential medications in terms of overall plan cost

  1. DUEXIS
    • Use: Osteoarthritis
      • Brand Cost: ~$2,200 for a typical 30-day supply
      • OTC Alternative Cost: ~$35 for a typical 30-day supply
  2. PENNSAID
    • Use: Osteoarthritis of the knee
      • Brand Cost: ~$2,200 for a typical 30-day supply
      • OTC Alternative Cost: ~$35 for a typical 30-day supply
  3. JUBLIA
    • Use: Nail fungal infections
      • Brand Cost: ~$900 per 8mL(a typical 30-day supply)
      • Prescription Alternative Cost: ~$75 for a typical 30-day supply

It’s time to consult an independent expert to evaluate whether your plan has an opportunity to optimize your formulary by eliminating these high-cost non-essential medications. There are significant savings associated with replacing these medications with cost-effective, clinically equivalent alternatives.

By targeting a few high-cost drugs, plans can avoid unnecessary pharmacy benefit costs with minimal member disruption.

Check out our free e-book, Building an Optimal Clinical Playbook to learn about other drug manufacturer pricing practices that may be contributing to unnecessary spending in pharmacy benefits plans.

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