The Paradigm Shift
When drug spend was largely driven by traditional brand drugs, scale was important when negotiating rebates with drug manufacturers. It’s no longer about the highest rebate. Today, 90% of traditional prescriptions dispensed are generic and 50% of pharmacy costs are driven by the 2% of the patients taking specialty medications. In today’s world, distinct programs for complex patients that drive pharmacy spend – programs that manage utilization while engaging patients and physicians, are key to controlling costs.
In 2018, Americans filled 5.8 billion 30-day equivalent prescriptions, up 2.7% over the prior year at a rate of 17.6 prescriptions per person. Generics made up approximately 90% of prescriptions dispensed, up from 75% in 2009. Specialty medication use, which represents only 2.2% of volume, grew by more than twice the rate of other drugs, but they account for approximately 50% of drug costs. Therefore, in order to manage drug costs, healthcare payers need PBM partners with proven success in managing specialty care.
US Specialty Care (USSC), WellDyneRx’s wholly owned, award-winning specialty pharmacy, kept specialty trend at 5.7% in 2018 by leveraging strategic clinical initiatives. This is in contrast to large, national specialty pharmacies that reported a trend of 11% during the same time frame. Likewise, specialty medications are typically very expensive for the patients as well as the plan provider, and while most pharmacies try to help their patients navigate complicated discount programs, USSC truly excels in this area. In fact, approximately 97% of USSC patients (who had a copay and for which there was a copay card available) are taking advantage of a reimbursement program to help alleviate their costs and minimize financial stresses. Our staff understand that medication costs can present a significant barrier to adherence rates and they work with each patient to identify appropriate manufacturer copay assistance programs, grants, or discount coupons.
Winner of the 2017 Specialty Pharmacy Patient Choice Award™, and a finalist in 2018 and 2019, the USSC staff understand that engaged patients are more adherent to their therapies. Multiple studies have proven that improved medication adherence helps lower overall healthcare costs and improve overall quality of life. USSC, with its strong focus and commitment to excellence, builds and fosters relationships with both patients and providers to ensure barriers to medication adherence are mitigated. This, in turn, reduces costs for our clients. Over 90% of all USSC patients are adherent to their medication regimens, with overall adherence rates higher than 90% for the most expensive and utilized categories. These include Inflammatory Conditions (92% adherence rate), Multiple Sclerosis (92% adherence rate) and HIV (95% adherence rate).
To learn how WellDyneRx can help contain your plan’s specialty drug costs, contact your Account Executive.
References: IQVIA Institute. Medicine Use and Spending in the U.S. A Review of 2017 and Outlook to 2022. 19 Apr. 2018,
2019 Quarter Three WellInformed Table of Contents
- The PBM Paradigm Shift
- WellDyneRx Named a Best Place to Work by CareerSource
- ACA Changes to Preventive Care Coverage Requirements
- IRS High Deductible Health Plan (HDHP) Rules
- Flu Vaccinations and Recommendations
- What are Biosimilar Medications?
- H2 2019 Drug Pipeline Reports
- Upcoming Trade Shows, Conferences & Events
- Healthcare Observances September
- FDA Approved List