As the Manager of Clinical Pharmacy Services, I promote clinically appropriate, evidenced-based therapies for prescribing quality medication use and cost savings to Privia Medical Group Physicians. It’s just one of the many ways that Privia removes burdens from our physicians so they can focus on providing quality care to their patients.
Pharmacy costs are skyrocketing these days, not only for patients, but for payers and providers. The avoidable cost potential in prescription drug management is sizable, and it consistently ranks as a top opportunity to reduce spending across all payer populations.
One manageable way to decrease pharmacy spend is through brand to generic or therapeutic alternative prescription conversion programs. Choosing cost-effective therapy is key in order to be successful in value-based contracts. In fact, many payers include a Generic Dispensing Rate when calculating shared saving and incentive payments.
At Privia, The doctors I work with are serious about minimizing unnecessary spend on brand name drugs. The advantage of medication switches is a substantial cost savings for patients and their health plans, including government plans. In some cases, switches can increase the quality of care while reducing costs by removing financial barriers which can often lead to non-adherence and uncontrolled disease burden.
Keep in mind that, when compared to their brand-name counterparts, generic drugs generally:
- Contain the same active ingredient(s)
- Have similar dosage, strength, safety, and quality
- Have similar benefits, side-effects, and risks, and work the same way in the body
- Are usually more cost-effective
- Are sometimes even made by the same drug company that makes the brand-name product
Keeping these principles in mind, our Clinical Committee has implemented a standardized quarterly process for targeted brand drug conversion, called the Pharmacy High Five Program.
The goal of the Pharmacy High Five Program is to improve Privia’s overall Generic Dispensing Rate (GDR) for our attributed population through an ongoing Drug Utilization Review process. On a quarterly basis, a list of drugs with potential for member and organizational cost savings are identified by Privia’s Pharmacy Program based on payer reporting.
Once data is collected, a Privia Pharmacist performs a formal Drug Utilization Review which outlines current utilization and opportunity for cost savings. The Drug Utilization Review is then presented to and approved by the Clinical Committee for rollout on the provider level. Providers review their lists of patients and evaluate whether it is clinically appropriate to change medications to lower cost, but equally efficacious alternatives. All conversions are completely voluntary and left to provider clinical judgement. If authorized to switch, Privia’s Pharmacy team reaches out to the patient and facilitates a script change, provides medication counseling, and coordinates with the patient’s pharmacy.
Last quarter alone, over $4.3 million dollars of spend was identified for commonly prescribed drugs such as statins and blood pressure medications and nearly 30% of those scripts were converted to a lower cost alternative, a tactic which resulted in nearly $600,000 of savings for Privia Medical Group physicians and patients.*
What are your thoughts on brand to generic conversions? Has your practice benefitted from savings by converting to lower cost alternatives? Let me know in the comments below!
* This number is based on average wholesale price (AWP) of Brand drug per 30 day supply minus the average wholesale price of the generic alternative per 30 day supply = estimated cost savings. This figure does not reflect shared savings achieved nor does it reflect true out of pocket expense for patients. It does represent overall cost savings, looking at drug costs alone.