By COLLEEN CREAMER
For VerusMed
Greater use of generic drugs can reduce overall pharmacy spending by as much as 15 percent. However, providers need to get this message out to consumers, even if a complex approach based on marketing and consumer psychology is required, according to policy experts.
“Two out of three [consumers] say they are comfortable talking with their physician or pharmacist. Less actually ask their pharmacist [about generic drugs]. Even less ask their physician, and far less have their pharmacist or physician ask them,” said Dr. Edmond Weisbart, policy advisor for Express Scripts.
Weisbart said a 1 percent hike in generic fill rates (GNF) translates to a 1 percent greater decrease in plan sponsor spending.
“I think we can get to an 80 or 85 percent generic fill rate without compromising clinical outcomes, and yet none of us are there,” Weisbart said.
In a 2007 cost analysis of drug classes and the disparity between fill rates and potential fill rates, Express Scripts found that the highest annual savings could be seen with gastrointestinal drugs, antihyperlipidemics, antidepressants, antihypertensives and anticonvulsants, respectively. When factored out to the whole country, this amounted to approximately $40 billion annually.
For “obvious reasons,” Weisbart added, patients who have little or no copay do not talk to their physicians about costs. However, even consumers who are more liable for their pharmacy costs demonstrate little interest in finding out about generic equivalents.
“The discussion is just not happening,” he said, adding that a number of steps can be taken to get consumers engaged.
If providers only changed their formularies, the increase in switching from the branded drug to the generic equivalent would be nominally felt, he noted. However, even a simple letter informing policy members that a generic has become available can double that number.
“This is really one of the best pieces of evidence that I have seen. The letters actually do get read. There is a measurable impact,” said Weisbart.
Although communication matters, social norms appear to trump marketing norms. Though there might be a financial incentive to asking one’s physician about generics or other cost-saving measures, a fear of questioning one’s doctor can override that impulse. It is all in the presentation.
Three things, he said, are true about messaging: that financial incentives alone are “surprisingly” weak; one size does not fit all; and intuition, or a gut feeling about what consumers will react to, is “not enough.”
Further, in order to market relevantly, Weisbart said that providers would do well by harvesting demographic data and creating segments to which they can deliver their message. Improved therapy compliance in key drug classes where adherence is critical to a member’s health, is another opportunity for better managing pharmacy benefit, he commented.
In 2006, Express Scripts implemented a person-by-person campaign that included mail, telephone, the Internet and other venues and delivered specifically tailored messages honed to make it through to plan members. The result, Weisberg notes, was “the largest intentional market-share shift in the history of pharmacy.” He said plan sponsors and members saved more than $126 million in ingredient costs and copayments and $600 million in savings to date.
Weisbart said that no matter the message, if the delivery is not in line with what patients are at ease with, the message will not be effective, whether it is mail, web-based or other.
“The biggest driver is whether or not they [patients] were comfortable with the process,” Weisbart concluded.
