Specialty Parity Pricing
Specialty Parity Pricing is a hidden tactic used by pharmaceutical manufacturers to drive additional revenue – at the expense of unsuspecting payors. Medications that are parity priced have the same cost per unit regardless of the strength. Cancer medications and other specialty medications typically experience parity pricing more than others. Many prescribers are unaware of the pricing tactics used against their patients.
The lack of optimal dosage with parity priced medications can result in the plan sponsor paying more for the medication than is necessary to successfully treat the member’s condition. Dispensing pharmacy audits, data analysis and utilization management are essential to identifying these claims and ensuring that necessary doses are correctly dispensed.
A mid-size chemical manufacturer in the Southeastern United States had a projected annualized spend of $1.14M, or $94.95 PMPM, before partnering with RxBenefits. During a data analysis focused on identifying parity priced medications, RxBenefits discovered a member who was receiving a cancer medication that accounted for 39% of total plan costs. Upon review of the medication, it was concluded that the medication was affected by parity pricing.
Along with the parity pricing tactic, the member was not receiving an optimal dosage. The existing prescription dosage of Cabometyx of three 20mg tablets was costing the mid-size manufacturer $64K in monthly pre-rebate costs and $768K in annualized costs. The member was receiving a total of 270 tablets every 90-day supply to achieve the prescribed dosing. Both the parity pricing and the dose management had gone unnoticed by the pharmacy benefit manager (PBM), the physician, and the pharmacy.
Upon identifying the claim, RxBenefits’ team of clinical pharmacists quickly intervened to optimize the dosing of this claim. In partnership with the RxBenefits Account Management Team, they were able to notify and discuss the findings with the prescriber. RxBenefits’ evaluation concluded that safely switching the daily dose from taking three 20mg tablets daily to taking one 60mg tablet daily would be the most optimal therapy for the member. The switch in dosage would reduce the number of units daily by over half, thereby cutting the cost as well.
RxBenefits’ dose optimization intervention helped the organization limit unnecessary spending and lowering their total pharmacy plan costs. The optimal drug therapy resulted in a reduction of $44.22 PMPM with an expected annualized cost reduction of $516K, or 67%.