Controlling
prescription drug expenditures: A case report of
success
Newswise — As national
spending on prescription drugs rose faster than
any other segment of health care spending, the
health plan at Wake Forest University Baptist
Medical Center was able to maintain constant
spending, resulting in savings of more than $6.6
million over three years.
Four health plan
interventions not only averted increases in
prescription drug spending but also preserved
members’ use of medications for chronic
conditions, according to a manuscript published
today (Aug. 7) in The American Journal of
Managed Care.
“Other studies have found
that single cost-control strategies such as
increasing co-payments can decrease prescription
drug spending,” said lead author David P.
Miller, M.D., assistant professor in the Section
of General Internal Medicine at Wake Forest
University School of Medicine. “However, we
present the results of a combination of
strategies used in concert.”
The manuscript describes a
three-year observational study conducted at the
Medical Center, comprised of Wake Forest
University Health Sciences and North Carolina
Baptist Hospital. The institution, with more
than 11,000employees, ranks among the top 15
largest employers in North Carolina. Employees
of both organizations are members of the health
plan.
“One reason for this
success may be that the plan was careful to
avoid shifting costs to its members,” said
Miller. “Whenever a drug was changed to a more
expensive tier or removed from the formulary,
the members’ out-of-pocket costs were the same
or less if they changed to the less-expensive
alternative.”
The interventions included
reclassifying select brand-name drugs to
non-preferred status (resulting in approximately
half of the annual savings), followed by (in
descending order of savings) the removal of
non-sedating antihistamines from the
prescription-drug formulary, the introduction of
pill-splitting, and the limitation of quantities
of select medications not intended for daily
use.
The health plan’s goal,
according to the study’s authors, was to
control prescription drug spending while
preserving high quality medical care. An
advisory outpatient prescription drug
committee, which included physicians and
pharmacists, was formed to review the
literature and ensure that proposed
strategies wouldn’t have a negative impact
on health care quality.
According to co-author Curt
D. Furberg, M.D., Ph.D., professor of public
health sciences, “The study demonstrated that
much of what we spend on prescription drugs is
wasteful, and that other institutions,
hospitals, health plans, state and federal
governments can learn from our experience.”
The study’s authors wrote
that preventing the rise of prescription drug
costs allowed the health plan to invest in new
initiatives to improve the health outcomes of
patients with chronic disease, such as reducing
the co-payments for insulin and diabetic testing
supplies to encourage medication adherence and
monitoring.
Another co-author, Ronald
H. Small, M.B.A., vice president for quality
outcomes, noted that the collaboration between
physicians and the hospital worked well to
ensure not only that cost savings could be
achieved but also that employees received
pharmaceuticals that are shown by evidence to be
effective.
Besides Miller, Furberg,
and Small, the authors of the study include
Franklyn M. Millman, M.D., Walter T. Ambrosius,
Ph.D., Julia S. Harshbarger, PharmD, and
Christopher A. Ohl, M.D., all with Wake Forest.
Wake Forest University
Baptist Medical Center is an academic health
system comprised of North Carolina Baptist
Hospital and Wake Forest University Health
Sciences, which operates the university’s School
of Medicine. The system comprises 1,154 acute
care, psychiatric, rehabilitation and long-term
care beds and is consistently ranked as one of
“America’s Best Hospitals” by U.S. News & World
Report.
