How AllianceRx Walgreens Pharmacy Provides Cost Savings to Payers
Specialty medication are products that treat chronic, complex, or rare diseases and have some of the following characteristics: cost of ≥$6,000/year, require special handling or administration, have significant side effects or monitoring, and other criteria.1 In 2010, specialty drugs made up 27% of medication spending. A decade later, specialty drugs have risen to 53% of medication spending with autoimmune disorders and oncology therapies leading this growth.2
What Makes Specialty Products Expensive
At the time of their approval, many specialty drugs make huge clinical leaps with regards to patient outcomes. These medications may be the only option for a patient’s disease or have made great improvements to those options previously available. With the complex research required to bring these medications to market and a relatively smaller patient population, specialty medications often come with higher costs.2
The medication pipeline shows an estimated 50-55 new products coming to market per year adding $133 billion in spend growth through 2025. New medications are increasingly specialty products with a focus on rare diseases. With specialty products being relatively newer, compared to traditional medications, many do not have available generics. However, as the specialty landscape ages, the generic and biosimilar pipeline is expanding and expected to provide $128 billion in cost reductions through 2025.2
Specialty Savings Programs Available at AllianceRx Walgreens Pharmacy
AllianceRx Walgreens Pharmacy has many opportunities to identify areas of savings by reducing the cost of the medication being dispensed. These opportunities are identified and conducted without impacting the therapeutic or clinical needs of our patients or prescribers. With many patient copays being set amounts, savings from these programs is most often seen at the payer level. Most commonly, these are done as part of the dispensing process.
• Generic Substitution – A standard practice of all pharmacies and often mandated by state laws. Unless requested by a patient or physician, a brand name product is substituted with a less-expensive generically equivalent product.
• Oncology Split Fill – Severe side effects of oral oncology products can lead to discontinuations. In addition to other support for these patients, a prescription can be dispensed in smaller, more frequent fills. If a patient does require therapy discontinuation or dose modification due to experiencing adverse side effects, a lower amount on hand leads to a reduction in waste.
• Assay Management – Certain medications, such as some hemophilia products, are manufactured with different batches having different levels of activity in the body. These medications are known as assays. Most physicians prescribe hemophilia products as a target dose ±10%, allowing pharmacies to utilize available assays to achieve the appropriate dose. While multiple available assays can fall within this range, products at the high end of the range come with additional costs. Additional processes to narrow this range, such as using multiple assays, may reduce the overall cost while also meeting the therapeutic needs of the patient.
After a product is dispensed, AllianceRx Walgreens Pharmacy does not stop looking for opportunities for cost savings. Many prescriptions are reviewed by a pharmacist after dispensing to identify additional savings opportunities through our Clinical Audit Programs.
• Dose Optimization – Certain medications carry the same price tag regardless of the dose. The cost of a patient using two 5mg tablets may be more than if the patient were using one 10mg tablet. Obtaining prescriber approval for these changes can lead to significant savings. In 2022, AllianceRx Walgreens Pharmacy realized $4.2 million in annualized savings through its dose optimization program, leading to an average savings of $3,433 per optimized dispense each month.
• Weight-based Dosing – Many medications are dosed based on a patient’s body weight. At times, this can lead to a patient utilizing a small amount from an additional vial for the prescribed dose. If possible, and with prescriber approval, a dose can be slightly rounded down to avoid wasting the majority of an additional vial while maintaining the therapeutic needs of the patient.
• Hepatitis C – Many patients require 8-12 weeks of hepatitis C therapy. Reviewing patients for eligibility of an 8-week therapy, based on current guidelines, can reduce the cost of an additional dispense.
AllianceRx Walgreens Pharmacy also works directly with payers to implement programs tailored specifically to their needs. At times, payers may have preferred medications in specific disease areas. AllianceRx Walgreens Pharmacy works directly with our payer partners and prescribers to implement these initiatives.
AllianceRx Walgreens Pharmacy’s Role
As a dispensary, AllianceRx Walgreens Pharmacy has the last opportunity to provide cost savings. To minimize delays in therapy, certain interventions occur after the medication is dispensed. Although these savings are primarily provided to the payer, these savings can be passed to the patient through lower insurance premiums. When the costs of medications are decreased, through copays or lower premiums, AllianceRx Walgreens Pharmacy helps patients focus on better tomorrows.
Sources
1 Aitken, M, Kleinrock, M, Munoz, E, Porwal, U. Orphan Drugs in the United States: Rare Disease Innovation and Cost Trends Through 2019. IQVIA Institute for Human Data Science. December 2020.
2 Aitken, M, Kleinrock, M. The Use of Medicines in the U.S.: Spending and Usage Trends and Outlook to 2025. IQVIA Institute for Human Data Science. May 2021.
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