In the last few years, the market has seen a shift toward the use of generic drugs. Your prescription drug plan probably encourages it, and so does the local drug store; you can get a 30-day supply of many generic drugs for just $4 at several of the big name pharmacies.
Most benefits professionals can state off the top of their heads the names of the highest-cost prescriptions covered by their plan. You know the ones: Nexium®, Lipitor®, Prevacid®, or some of the other brand-name drugs commonly prescribed for your employees.
Because these drugs remain subject to a patent, they are not yet available as generics, and they may not be for many years. However, there is a secret about them that even most physicians may not know—there are equally effective drugs available at much lower costs. If physicians did know, and if they understood the true cost of the brand-name drugs, many would be willing to have their patients try an alternative, says David Smith of EquivaMeds (www.equivameds.com).
His company offers a way to find those drug alternatives and inform physicians about them. Patients can then have a conversation with their doctor about whether the alternatives should be prescribed. Savings on Lipitor, for example, could be in the $500 to $700 per year range, according to Smith.
The company started when one frustrated physician realized that his patient, a young woman for whom he had prescribed a commonly accepted medication, returned to him 3 months after he wrote her a prescription. Her symptoms were the same. She tearfully confessed that the medication cost $100 for a 30-day supply, and she couldn’t afford it. As the doctor researched alternatives, he realized that this scenario plays out over and over in the United States.
“There are other drugs that a doctor would consider as an option to these very expensive, brand-name drugs,” says Smith. “Why don’t they prescribe those in the first place? Because they don’t know. We often find that there is an ‘Aha!’ moment for the doctor, when he or she finds out the cost of the drugs they’re prescribing, and that there are good alternatives.
“There are too many drugs out there, too many drug plans, and too many formularies, for the doctor to know how much a patient will end up paying for their prescription. But if at the point of care, the doctors knew the cost, they might make different prescription decisions. When they see that someone could save $70 a month just on the co-pay, for example, they often say, ‘Sure, let’s try this other drug.’”