Our Response – Recent PBM News & Concerns

(May 9, 2018) You may have seen a piece by Lesley Stahl that ran on CBS’ 60 Minutes on Sunday night (5/6/2018) entitled “The Rockford File.” In it, she discusses a pending class-action lawsuit brought by the city of Rockford, Illinois against pharmaceutical manufacturer Mallinckrodt and their Pharmacy Benefits Manager (PBM). The reason? One drug in particular: HP Acthar. In 2001, Acthar sold for about $40 a vial. Today, it costs more than $40,000—an increase of 100,000 percent. These soaring costs have forced the city of Rockford to forego vital city improvements in staffing for police and firefighters, effectively pushing the city’s finances to the brink.

As a PBM, WellDyneRx would like to take this opportunity to highlight our approach and the different outcomes we’ve generated when it comes to HP Acthar. Knowing about this and other similar medications that have had high price increases, WellDyneRx decided to proactively combat this problem by creating the WellManaged – Hyperinflationary Drugs program. The WellManaged – Hyperinflationary Drugs program monitors the pricing and clinical relevance of new and existing medications. Drugs are added to an exclusion list if they are significantly more costly than medications offering similar clinical outcomes.

To date, WellDyneRx has identified 243 medications which are part of the Hyperinflationary Drugs program. Unfortunately, many of our clients have not implemented this program and are at risk of paying too much for medications that WellDyneRx deems “wasteful” because there are less expensive, clinically-equivalent options available.

Historical data demonstrate that clients spend just over 2% of their total drug spend on hyperinflationary medications, or approximately $1.25 PMPM. Implementing the WellManaged – Hyperinflationary Drugs program can generate savings of nearly $1.00 PMPM, when taking into consideration use of lower cost alternatives. Our numbers bear this out. In 2017, we avoided $11.4 million of costs for 43 patients through our Utilization Management protocols. Additionally, our clients incurred a total cost of $1.1 million on HP Acthar for a total of 19 members, effectively avoiding 90% of total drug costs for this medication.

Key Points:

  1. WellDyneRx is aware of egregious pricing practices and we have implemented WM – Hyperinflationary drugs to combat it.
  2. WellDyneRx puts our clients first. Our approach to indication based formularies is a great example of how we helped save clients money while others may have promoted higher cost options.
  3. Our UM protocols around HP Acthar have ensured appropriate use and avoided 90% of client costs which were inappropriate.

As always, WellDyneRx is committed to offering our clients and plan participants the best clinical prescription benefit options at the lowest cost. As a reflection of that commitment, WellDyneRx was the first PBM in the country to adopt a Hepatitis C indication-based formulary using Zepatier as our preferred product for patients with genotypes 1 and 4. Despite other PBMs promoting more expensive Hep C medications that enabled them to make more money on rebates, we stayed focused on providing the most cost-effective product for our clients. In short, it worked. Our efforts resulted in an average patient cost savings of 35%—or $33,551.

WellDyneRx formulary lists and utilization management strategies are continuously evaluated and updated by our clinical staff. If there’s a better — or more practical — prescription option for our clients and members, we tell them about it. With that transparency comes trust.

It’s why at WellDyneRx, quality care is our prescription.