PBM Formulary Waste Exposed in Commonwealth Fund Study

15 Self-Funded Employers Analyzed Their Pharmacy Claims Data in Conjunction with the Commonwealth Fund and Discovered the Following Regarding their PBM Formulary:

1) 868 Wasteful Drugs Were on the Formulary (see video for definition of wasteful)

2) Wasteful Drug Made up 6% of Pharmacy Claims and 3% - 24% of Rx Spend by Employer

3) Only 8 Wasteful Drugs Accounted for 21% of the Rx Savings: Metformin ER, Dexilant, Duexis, Mometasone, Absorica, Solodyn, Esomeprazole and Jublia.

4) Barriers to Removing These Wasteful Drugs from the Formulary Include: PBM Contracts, Benefit Consultant Negotiating Methodologies, Negative Patient Experience and Benefit Consultant Conflict-of-Interest from PBM/Carrier Payments.

Correction: I said this study was 'recently published.' This Study Was Published in August 2019.

Sources:

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#HealthcareCosts #Formulary #PBM

[elizabethlane]

Excellent overview of a well written study. Thank you!

[alangardner]

The sad news is there are many more than 868 wasteful drugs. Employers should consider engaging a pharmacy benefits risk manager for assistance with their drug coverage design. Also, patients need to be asking their pharmacists if there is "similar" or "therapeutic" alternative drug for the expensive drug they're currently taking instead of asking if there is a "generic" for their medication; especially if they are on a high deductible health plan.

[puesbien]

"Me Too" drugs had me thinking you were making a Bill Cosby joke.

[thSun]

I'm sure they will come out with a "me too" for placebo next.

[CharlieSpecter]

Conflict riddled consultants like AON, Willis Towers Watson, Mercer/MMA are major problems. They are massive firms that use sophomoric evaluation techniques to grade PBMs and have their own drug coalitions which only the Big 3 are allowed to participate. After the J&J lawsuit for a breach of fiduciary duty, Aon should have been listed as a defendant right there with them.