MIAMI, FL – MARCH 23: A bottle of the antidepressant drug named Paxil is displayed on March 23, 2004. … [+]
As Mental health burden The number of pandemics and even before pandemic is increasing, and the use of mental health drugs is increasing as well. However, new reports are not necessarily equal to more overall costs. It suggests.
according to Pharmacy Welfare Report Innovation: Mental Health is healthyAccording to the cost per person using mental health drugs, the overall use of these drugs decreased by nearly 5% between 2020 and 2021. The report was released last week by her EmpiRx Health, value-based pharmacy benefits manager, based on its claims data.
According to the report, mental health prescriptions will grow by more than 9% between 2020 and 2021, with 75% of those prescriptions for antidepressants. But the EmpiRx data shows that increased drug use does not automatically increase costs by the same percentage. For example, antidepressant use increased by 12%, but spending per claim he increased by less than 2%.
More dramatic results were reflected in drug usage and costs for attention deficit hyperactivity disorder (ADHD). While ADHD medication usage increased by more than 20% year-over-year, spending per claim on ADHD medications actually decreased by 9%. Notably, his ADHD prescriptions for adults over the age of 26 have increased consistently over the past three years, accounting for half of all ADHD drug users.
According to Karthik Ganesh, CEO of EmpiRx Health, the key to the company’s cost savings lies in its ‘value-based’ approach to pharmacy benefits, which is uncommon in the industry.
Pharmacy benefit manager (PBM) A company that manages prescription drugs on behalf of health insurance or large employers. PBMs typically set up and maintain lists of approved drugs for specific health plans and groups, and negotiate drug pricing directly with manufacturers. PBMs are essentially pharmaceutical intermediaries that stand between health insurance (and ultimately consumers) and pharmaceutical companies.
according to Federal FundLarge -scale PBMs, including CVS/CAREMARK, ExpressScripts, and Optumrx, dominate the market with a total market share of 79%.Such a newcomer Mark Cuban Cost Plus Pharmaceutical Company When Severe crip In particular, by reducing the cost of generic drugs, we are trying to interrupt them into market dynamics and change them.
Traditional PBMs operate on a volume-based model, where the more prescriptions they fill, the more revenue they generate. By buying and distributing prescription drugs in bulk, PBMs can negotiate lower prices or better rebates. They share at least some of these savings with payers, who are insurance companies or employers.
Value-based reimbursement does not reward providers who provide more of the services they provide, but all kinds of providers who provide the “right care” to the “right people” at the “right time” (value) A healthcare payment model that generally rewards (Volume).
In the context of pharmacy benefits, value-based models focus on ensuring that the most appropriate medicines are dispensed rather than on the number of prescriptions dispensed. This approach may lead to the use of prescribing patterns tailored to specific populations rather than applying general rules across the board. According to Ganesh, value-based pharmacy benefits management often incorporates a performance-based component as well, meaning that when a client (insurer or employer) saves more, his PBM finances improve. . Thus, value-based pharmacy benefits management adjusts financial incentives in ways that traditional his PBM cannot.
Ganesh stated that this approach would reduce waste (or low value spending). one quarter The percentage of medical expenditures as a whole was prompted to follow other people.
“PBM needs to fundamentally shift from a volume-based, condition-oriented model of care to an individualized population health care centered around holistic care,” he said.
Based on the premise that population health care focuses on the health risks of groups of individuals and may require different clinical strategies for different populations, Dr. Ganesh believes that improving the health of these groups We are designing an appropriate clinical approach for
“Public health approaches use a ‘less is more’ model to separate what is needed from what is not needed for a particular population or patient,” Ganesh said.
He argued that pharmacists can play a pivotal role in ensuring the adequacy of medications and ultimately reducing the cost of prescription drugs for populations and individuals.
“Pharmacists are at the intersection of patient care, reviewing and evaluating all medications prescribed by various health care providers,” he said. “As the only experts who see the full picture of patient medications and understand their impact, pharmacists are in a prime position to eliminate wasteful pharmacy spending for both patients and benefit plan sponsors.”
Because they know what drugs are available and how they work for people, pharmacists are good at identifying cost-effective alternatives to the most expensive drugs, Ganesh says. said Mr.
“Pharmacists can work directly with their patients’ physicians to influence more accurate prescription choices and prevent excessive costs without compromising care,” he said.
