A Disturbing Trend: Low-Cost Medications Disguised as High-Cost Drugs

https://page.elixirsolutions.com/hubfs/Documents/elixir_solutionoverview_ned_20-4838_vpf5.pdfOver the past several years, a trend has crept into the pharmaceutical industry where new, high-cost drug formulations are being created from existing lower-cost alternatives. These expensive new drugs provide no clinical advantage or health benefit and unnecessarily inflate drug spend. This is sometimes the case when pharmaceutical companies try to extend the life of patent protections by creating new brand prescription medications from already approved drugs—their own or generics—and marketing them at significantly higher prices.

While formularies are great tools for managing unnecessary drug spend, many do not address non-essential medications like these, quite simply because they’re hard to find. These medications don’t typically fall into a specific therapeutic class or even dollar amount per fill. They don’t set off any alarms and, in many cases, the manufacturers are advertising their medications to doctors and direct to consumers, often offering coupons and discounts to encourage use.

Examples of Non-Essential Drugs

Non-Essential Drug
sumatriptan and OTC naproxen
(topical diclofenac)
(topical solution)

The prevalence of non-essential drugs has increased significantly over time, as many patents have expired. Mitigating this trend can be a challenge since these drugs are not usually in the spotlight, like a specialty drug or biologic. They could very well be showing up in your claims right now, completely unnoticed.

Pulling the Mask Off High-Cost Non-Essential Drugs

With no way to stop these drugs from being filled short of evaluating every single prescription presented, Elixir started compiling a list of these non-essential drugs. Today, there are over 100 of these medications on our Non-Essential Drug (NED) List. These medications include new formulations and combination packages, as well as high-inflation products.

Elixir clients can add the NED program as an overlay to their formulary strategy. If a member tries to fill a prescription for a non-essential drug on the list, they are provided a clinically sound alternative approved by our Pharmacy & Therapeutics committee, comprised of independent clinical experts. Members have the opportunity to save on their medications, not just short term with a coupon, but long term using the most cost and clinically effective medication. There is no cost to the plan to participate in this program and clients can expect to see savings as much as 60% per prescription. This can equate to 2% annual savings.

The NED program is a win-win for everyone. Members get the medications they need at more affordable prices, and payers have an effective tool to better control unnecessary drug spend.