Generic drugs continue to save consumers and healthcare plan sponsors huge dollars when looking at total pharmacy spending. At WBC (wbcbaltimore.com) we help plan sponsors create the kinds of Rx plan designs that dramatically increases their generic utilization. During 2011, the use of generic prescription drugs saved $192 billion 
when compared to their utilization in place of brand name alternatives, according to the Generic Pharmaceutical Association. Yet, there is still room for improvement. According to a recent study published in JAMA Internal Medicine, 4 out of 10 physicians sometimes, or often prescribe brand name drugs just because the patient asked for it.
Rx Plan sponsors need to do a better job in plan design incentives that encourage plan participants to inform their doctor that they want the generic prescription, when appropriate. This means a reduction in the co-pay that the participant must pay when filling their prescription with the generic. Many plan sponsors have integrated a requirement where the plan participant pays the higher co-pay, plus the difference in cost between the generic and the brand name drug when a generic equivalent is available.
Plan sponsors must also do a better job in communicating the message regarding the therapeutic effectiveness of generic drugs. Too many folks still carry the perception that a generic drug is a lesser clinical option and represents some form of pharmaceutical knock-off. Off course, this is not accurate, The FDA requires that a generic drug must the bioequivalent and contain the same active ingredients as their branded cousin. Additionally, they must be identical in strength, dosage form and administration.
PBMs also have a vested interest in increasing generic utilization. It helps their clients save money, which helps them fulfill their business mission and produces larger profit margins for themselves. Most PBM service agreements today have a Generic Fill Rate (“GFR”) guarantee that sets a baseline guarantee for the percent of total prescriptions filled with a generic product. We believe a minimum GFR should be 75% with a target of 80% being realistic.
According to AIS’s Pharmacy Benefit Survey Results, 3rd quarter 2012 results showed an average GFR of 70.82% from 31 PBMs. Here are their results:
Company Generic Fill Rate
Meridian Rx 85.12%
4D Pharmacy Mgmt. 83.67%
NPS 83.00%
myMatrixx 82.40%
MedImpact 81.34%
Catamaran 81.30%
ScripNet 81.00%
US Script 80.71%
Humana 80.52%
Henry Ford 80.00%
Partners Rx 79.00%
United Drugs 77.99%
PDMI 77.75%
Envision 77.00%
OptumRx 76.90%
AmWINS Rx 76.40%
CIGNA 76.30%
Express Scripts (network) 75.30%
CVS Caremark 75.00%
Restat LLC 74.77%
Prime Therapeutics 74.10%
Navitus 73.50%
Aetna 72.30%
Pequot 70.00%
Benecard 68.00%
Express Scripts (mail) 63.00%
Commcare 52.60%
Diplomat Specialty 45.00%
OncoMed 43.00%
Avella Specialty 38.50%
Burman’s Specialty 10.00%
