Controlling prescription drug expenditures: a case report of success

WINSTON-SALEM, N.C. 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 dai

Contact: Karen Richardson
Wake Forest University Baptist Medical Center

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