U.S. employers eye cutting wasteful drugs worth $6 billion

A group of researchers has found that there are medications that could be less expensive alternatives that could be covered by employers based on the benefits provided to employees. Read this blog post to learn more.


A health plan covering thousands of California teachers stopped paying for a diabetes drug that cost $352 per prescription. In its place, the plan now pays less than $13.

The difference? Instead of getting a 1,000-milligram dose of metformin, members got two 500-milligram pills.

It’s just one example of what some employers call “wasteful drugs,” and a coalition of West Coast employers says there are hundreds more. At a time when U.S. President Donald Trump is pushing to trim drug costs for Medicare by tying them to prices in other countries, the coalition is on a crusade to cut company spending on drugs nationwide by simply noting the cheaper choices already available, drawing the ire of drugmakers.

A guidebook produced by the Pacific Business Group on Health and researchers from Johns Hopkins University identifies 49 medications with less expensive alternatives that could be cut from the lists of drugs covered by employers. The group has pushed its approach to large employers for two years. Now it’s focusing on mid-sized companies at conferences, with webinars and through an online Excel sheet designed to help any company identify savings.

Lauren Vela, senior director of member value at the coalition, said it all comes down to who gains in the end. “There are so many folks making so much money on the existing system that the folks who really know how the system works don’t have an interest in changing it,” Vela said by telephone.

Vela presented at three online conferences this summer, and has at least two scheduled for the early fall, she said.

The medications outlined in the guidebook accounted for more than $6 billion in U.S. retail drug spending in 2019, according to data compiled by Bloomberg from Symphony Health. Drugmakers have long been under attack for how they price medications sold in the U.S., and for their efforts to undermine rules on when their products can be sold generically for less.

On Sunday, just weeks before the presidential election, Trump announced he had signed a presidential order on the “most favored nation” plan, which would try to link Medicare Part B and Part D prices to lower prices paid by other countries. In response, groups representing drugmakers said this could hurt their ability to find and test for new medications, while House Speaker Nancy Pelosi said Trump’s action took “no real action” to lower prices.

Researchers aligned with the Pacific Business Group, meanwhile, have analyzed six months of drug use and more than 2.5 million scripts for 15 large self-insured companies. They found that 6% of all claims were for what the report termed “wasteful drugs.”

In the case of just one, the leukemia drug Gleevec, use of generic imatinib could cut the average wholesale price 96%, a savings of $108.28 per pill, according to the report. The group says hundreds of other drugs could be replaced similarly.

“Generic drugs are an important part of the full spectrum of health-care solutions,” said Julie Masow, a spokeswoman for Novartis, the Swiss-based maker of Gleevec.

But the drug, which lost patent protection in the U.S. in 2016, “will remain on the U.S. market to maximize choice for health-care professionals and patients,” Masow said, “and Novartis plans to continue financial support for eligible patients.”

The Pacific Business Group also calls out therapies that combine two existing, cheaper pills into a more expensive single dose. And they urge removing pricey drugs that offer only small changes for the consumer, such as certain extended-release formulations or different dosage concentrations.

Drugmaker pushback
While the Pacific Business Group’s guidebook is gaining support among companies, PBMs — which administer drug plans — and pharmaceutical companies are pushing back.

Drugmakers are taking issue with characterizing drugs as “wasteful.”

“Decision-making power on what medicines patients should take should rest with doctors,” Katie Koziara, a spokeswoman for the Pharmaceutical Research and Manufacturers of America, said in an email.

Koziara said her group favors reforming the rebate system “to help correct PBMs and payers’ misaligned incentives,” boost transparency and share rebates directly with patients.

A trade group for PBMs, meanwhile, disputed the Pacific Business Group’s guidebook, saying it was based on limited data.

Greg Lopes, a spokesman for the Pharmaceutical Care Management Association, called the reports “dated” and said, “PBMs are the only entity in the supply chain reducing drug costs for consumers.”

Pharmacy benefit managers negotiate with drug manufacturers on behalf of employers, determining which drugs should be covered. But the employers say that the way PBMs’ services are sold makes it tough to tell whether they’re really saving money.

PBMs and consultants will typically present a spreadsheet that shows administrative fees, discount off-list prices, and rebate payments. The rebates flow from drugmakers to PBMs and ultimately back to plan sponsors, like employers or unions.

But Vela says employers often can’t easily tell if PBMs retain a portion of the rebates or other payments that incentivize them to keep expensive drugs on the formulary. “You’re hiring an entity to negotiate on your behalf, and the party with whom they’re negotiating is giving them money you don’t know about,” Vela said.

As the PBM business model has come under more scrutiny, benefit managers have pledged to be more transparent with rebates and pass them back to employers.

After recent mergers, the three largest PBMs are now part of companies that also own health insurers, pharmacies and other medical providers: UnitedHealth Group’s OptumRx; CVS Health Caremark; and Cigna Express Scripts.

None of the three leading PBMs would comment on the guidebook analysis.

The array of discounts and rebates PBMs tout to their clients often obscures the fact that employers are paying for high-priced drugs when lower-cost alternatives exist, according to Thomas Cordeiro, a co-author of the guidebook and president of consultant Integrity Pharmaceutical Advisors.

“Just because you have a high rebate doesn’t mean your cost is going to be low,” Cordeiro said.

SOURCE: Bloomberg News. (14 September 2020) "U.S. employers eye cutting wasteful drugs worth $6 billion" (Web Blog Post). Retrieved from https://www.employeebenefitadviser.com/articles/u-s-employers-eye-cutting-wasteful-drugs-worth-6-billion


What to consider when redesigning a benefits program

"The secret sauce to getting employees engaged and on board is to create and promote a culture of health." Check out this article from Employee Benefit Advisor for an insight look at designing successful benefit programs.


The concept of design is matching people’s needs with what’s technologically feasible — and redesigning health plans is no different for employers looking to shake things up.

Creating a culture of health, rather than looking at plans as a way to curb costs, should be a priority for benefits executives when they redesign benefits programs, a panel of industry insiders said recently at the National Alliance of Healthcare Purchaser Coalitions conference in Arlington, Va.

Employers must have design standards and strive to make things better for employees, explained Marcia Peterson, manager of benefit design and strategy at Washington State Health Care Authority. That was her strategy when WSHCA redesigned its benefits program. She wanted to change the experience from start to finish and looked to the Bree Collaborative, an evidenced-based quality standard, as her blueprint for design, she said.

The goal of the collaborative is to identify and recommend evidence-based strategies in areas where there is unnecessary change in the way care is delivered and/or increased care that isn’t improving outcomes.

[Image credit: Bloomberg]
[Image credit: Bloomberg]

“What we focused on was the member experience and quality … not cost,” Peterson said, comparing healthcare purchasing to buying a cup of coffee.

“If we bought coffee the way we bought healthcare, it would be awful,” she said, noting consumers would need to get a cup from one vendor, some beans from another and then find someone to grind the beans.

But there is a disconnect in benefit plans between what employers say and what employees feel, added Ron Goetzel, vice president, consulting and applied research, at IBM Watson Health. He suggests employers find what the employee pulse is when designing benefit programs.

“We always look at the cost, but we never ask the consumer about the process,” he said. The secret sauce to getting employees engaged and on board, he said, is to create and promote a culture of health.

Goetzel said employers have the misconception that if they pay employees to quit smoking or eat healthy that they’ll do it. “Money alone won’t do it; it’s got to be an internal motivation,” he says. Employers need to exude health and wellness as a part of the organization. “[Employees] do it because they want to have a healthier family, money may be the wrong signal,” he adds.

In designing benefit plans, the goal should not to contain healthcare costs, said Ray Fabius, co-founder of HealthNEXT, a healthcare consulting group. “The real goal is to bend the healthcare cost curve, and it’s possible,” he said.

For the last 50 years, medical inflation has exceeded general inflation by about two to one, he explained. And that’s despite the fact that “we’ve come up with all these benefit designs — from HMOs to PPOs and now HDHPs and benefit exchanges.” Still, he said, one thing is absolutely certain: changing design by itself is not going to stem the march of higher costs or make a workforce more productive.

Echoing Goetzel, Fabius said that talking to and surveying employees about what they want from their benefits can be insightful and even therapeutic.

“You have to keep the well people well, reduce the risks of the high-risk and help people with chronic illness not succumb to the complication of their chronic conditions,” he said of designing benefit programs.

 

Read the original article.

Source:
Otto N. (20 November 2017). "What to consider when redesigning a benefits program" [Web blog post]. Retrieved from address https://www.employeebenefitadviser.com/news/what-to-consider-when-redesigning-a-benefits-program?brief=00000152-1443-d1cc-a5fa-7cfba3c60000

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Obama to Propose Cuts to Social Security

Source: http://www.benefitspro.com

By Jim Kuhnhenn

President Barack Obama's proposed budget will call for reductions in the growth of Social Security and other benefit programs while still insisting on more taxes from the wealthy in a renewed attempt to strike a broad deficit-cutting deal with Republicans, a senior administration official says.

The proposal aims for a compromise on the Fiscal 2014 budget by combining the president's demand for higher taxes with GOP insistence on reductions in entitlement programs.

The official, who spoke on a condition of anonymity to describe a budget that has yet to be released, said Obama would reduce the federal government deficit by $1.8 trillion over 10 years. The president's budget, the first of his second term, incorporates elements from his last offer to House Speaker John Boehner in December. Congressional Republicans rejected that proposal because of its demand for more than a $1 trillion in tax revenue.

A key feature of the plan Obama now is submitting for the federal budget year beginning Oct. 1 is a revised inflation adjustment called "chained CPI." This new formula would effectively curb annual increases in a broad swath of government programs, but would have its biggest impact on Social Security. By encompassing Obama's offer to Boehner, R-Ohio, the plan will also include reductions in Medicare spending, much of it by targeting payments to health care providers and drug companies.

Obama's budget proposal also calls for additional tax revenue, including a proposal to place limits on tax-preferred retirement accounts for wealthy taxpayers. Obama has also called for limits on tax deductions by the wealthy, a proposal that could generate about $580 billion in revenue over 10 years.

The inflation adjustment would reduce federal spending over 10 years by about $130 billion, according to past White House estimates. Because it also affects how tax brackets are adjusted, it would also generate about $100 billion in higher taxes and affect even middle income taxpayers.

The reductions in the growth of benefit programs, which would affect veterans, the poor and the older Americans, is sure to anger many Democrats. Labor groups and liberals have long been critical of Obama's offer to Boehner for including such a plan.

Administration officials have said Obama would only agree to the reductions in benefit programs if they are accompanied by increases in revenue, a difficult demand given the strong anti-tax sentiment of House Republicans.

That Obama would include such a plan in his budget is hardly surprising. White House aides have said for weeks that the president's offer to Boehner in December remained on the table. Not including it in the budget would have constituted a remarkable retreat from his bargaining position.

Obama's budget, to be released next Wednesday, comes after the Republican-controlled House and the Democratic-run Senate passed separate and markedly different budget proposals. House Republicans achieved long-term deficit reductions by targeting safety net programs; Democrats instead protected those programs and called for $1 trillion in tax increases.

But Obama has been making a concerted effort to win Republican support, especially in the Senate. He has even scheduled a dinner with Republican lawmakers on the evening that his budget is released next week.

House Republicans, however, have been adamant in their opposition to increases in taxes, noting that Congress already increased taxes on the wealthy in the first days of January to avoid a so-called fiscal cliff, or automatic, across the board tax increases and spending cuts.

Congress and the administration have already secured $2.5 trillion in deficit reduction over the next 10 years through budget reductions and with the end-of-year tax increase on the rich. Obama's plan would bring that total to $4.3 trillion over 10 years.

As described by the administration official, the budget proposal would also end a loophole that permits people to obtain unemployment insurance and disability benefits at the same time.

Obama's proposal, however, includes calls for increased spending. It would make pre-school available to more children by increasing the tax on tobacco.