Out-of-Pocket Prescription Drug Expenses Are Manageable

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As the cost of healthcare increases, the cost to payors and patients has increased as well. This should not be a surprise to anyone. This article however blatantly misrepresents the facts.

  • Yes, more people are on HDPs. However, the article never mentions the increase of HSA and HRA programs to offset this cost.
  • Pharma is offsetting a large portion of these increases with copay assistance and patient assistance. Raising the copay is no longer a slam dunk to move patients to a preferred alternative.
  • The measurements of the percent of drugs covered is based on the number of drugs available – not on the number of drugs prescribed. Around 85% of all medications used are generics, which are seldom impacted by PBM UM programs. The authors are not using a weighted average. The 18% basis point drop is nothing more than an attempt to overstate the issue.

Finally, the article is based on a paper from GoodRx. GoodRx generates revenue when patients seek access to a medication that is restricted or not covered by their plan as opposed to using the preferred therapy. Raising concern over out-of-pocket (OOP) prescription drug expenses increases use of their product.

Rx therapy is effective and affordable. If your members are struggling with OOP prescription drug expenses, then your PBM is not doing its job. Araya has many clients that are holding down both costs and member contribution. Contact us if you want to learn more.

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