With health care costs rising at an alarming rate – approximately twice the rate of inflation – health coverage has become a growing concern for everyone. For most of the past two decades, prescription drug prices led the way, rising twice as fast as other medical costs. Though drug price escalation has leveled off somewhat, it remains a major component of health care cost inflation.
In 1995, LaboreRx, the LHSFNA’s pharmacy benefit program for Laborers, was introduced to help health and welfare funds administer their prescription drug coverage in a more cost-effective manner. The LHSFNA currently has an agreement with Express Scripts (ESI), one of the nation’s largest pharmacy benefits managers (PBMs), which, by combining their purchasing power, provides participating LIUNA health and welfare funds access to discounts at retail pharmacies and through mail order service as well as through a number of disease management programs and specialty pharmacy services.
An important way to save money in prescription medication is the encouragement of generic drug use. A generic pharmaceutical product is the bioequivalent of a brand name drug because the Food and Drug Administration (FDA) holds its manufacturer to the same rigid standards as the brand name maker. However, the average price of a generic is far below its brand name equivalent. Today, more than 45 percent of U.S. prescriptions are filled with generic drugs.
Clearly, if Laborers and their families use generic drugs, they and their health and welfare funds can save money.
To encourage generic use, ESI recently introduced an incentive program called Zero Dollar Co-Pay. If a health and welfare fund opts for this program, first time users of specific generic medications will have a zero dollar co-pay for a period of six months.
Step therapy is the practice of beginning therapy for a medical condition with the most cost-effective and safest drug and progressing to other more costly or riskier therapies, only as necessary. The goals are to control costs and minimize risks.
The program allows for tight control of product usage within each step of the therapy. This approach ensures that members always receive the plan’s preferred medication, resulting in the greatest cost savings. Should that medication not work well, the physician’s authorization moves the patient to the next level of treatment.
According to ESI, LIUNA health and welfare funds may achieve a cost reduction of up to 24 percent per member per monthly drug expense by participating in a step therapy program.
Fueled by a biotech surge, spending on high-cost “specialty” medications for people with complex, chronic conditions – ranging from rheumatoid arthritis to multiple sclerosis to cancer – has grown by more than 25 percent in recent years. This growth rate is approximately double the national average increase in drug spending (13.4 percent).
CuraScript, a division of Express Scripts, handles all biotech prescriptions for LaboreRx participants with costs of at least $1500/month or a requirement of frequent dosage changes. This is a small portion of ESI’s total prescription service, so this is a very focused effort for members with specific needs.
Specialty medications often require refrigerated or other special shipping arrangements, and CuraScript provides the necessary services, including the cotton swabs, hypodermic needles and other supplies that may be necessary to administer the medication. Counseling services, as well as 24 hour nursing care, are also available if necessary.
Mail Order Services
For convenience and savings, patients requiring medication on a regular basis – for example, blood pressure, cholesterol or diabetes medications – can have them mailed directly to their home or office. These maintenance medications are usually ordered as a 90-day supply.
It is recommended that patients take any new prescription to a local retail pharmacy for its first filling, to make sure the medication is the proper dosage and works without adverse reactions. Once those concerns are addressed, the member can begin a mail order program.
A list of available generics and information on medicines can be obtained through the Express Scripts website at: www.express-scripts.com. Members in plans participating in the LaboreRx program can manage their prescriptions and refills directly through the website or by calling toll free 1-800-548-6242.
For information regarding your plan’s pharmacy benefits and LaboreRx, contact your local health and welfare fund.