How can USI help our organization gain better control of our pharmacy benefit costs?
USI assists clients in implementing step therapy programs designed to direct members toward generic drugs or lower-cost therapeutic equivalents prior to filling more expensive prescriptions.
With USI’s guidance, step therapy programs can result in an estimated 4% to 5% savings on pharmacy benefit costs.
We’ve estimated the financial impact for you. Feel free to update the assumptions.
- Encourages utilization of lower-cost drugs by requiring members to document that higher-cost drugs are medically necessary and/or the only appropriate option for their treatment
- Provides guidance that challenges aggressive advertising for new prescriptions that makes no mention of existing, lower-cost drugs that effectively treat conditions for many individuals
Not necessarily. Prescription drug manufacturers aggressively market their products in ways that may create misaligned incentives or demands for expensive medications, when therapeutically equivalent lower-cost drugs are available.
Step therapy is typically used for classes of medication that have one or more therapeutic equivalent, such as sleep aids, anti-hypertensive, and gastro-intestinal medications.
I’d like to explore further how USI can help our organization gain better control of our pharmacy benefit costs.
We will need just a few pieces of information from your organization, including a detailed plan design, a utilization report of pharmacy claims, and a recent pharmacy audit report, if available.