Generic drugs continue to save consumers and healthcare plan sponsors huge dollars when looking at total pharmacy spending. At WBC ( 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%



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