Benefits March 20, 2009

Requiring Generics for Rx's a "Mis"Step for Health Care Costs?

March 20, 2009 (PLANSPONSOR.com) - A new study indicates that a common cost-containment tool that substitutes less expensive generic medications for costlier brand name drugs, referred to as step therapy, may actually lead to higher overall health care costs.
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The study focused on anti-hypertensive drugs, but found that benefit plan members subject to step therapy incurred $99 more in quarterly health care expenditures than a comparable group, Business Insurance reports. Additionally, the study found plan members in step therapy programs also had more inpatient admissions and emergency room visits.

Tami L. Mark, lead author of the study and director of analytic strategies at Thomson Reuters Healthcare in Washington suggested this might be caused by patients not filling their prescriptions. “You go to a doctor and the doctor prescribes a drug-not knowing that it has to be a generic-and you find out it’s not covered or more expensive than you had expected, so you don’t fill the prescription,” Mark said, according to Business Insurance.

Mark advised employers to make sure doctors know about step therapy requirements.

The study compared the health care costs of 11,851 employees and dependents at two companies with benefit plans that required step therapy with 30,882 employees and dependents of two companies that did not. Data for 2003 through 2006 came from MarketScan Research Databases kept by Thomson Reuters.

“The Effects of Antihypertensive Step Therapy Protocols on Pharmaceutical and Medical Utilization and Expenditures” was published in the February issue of the American Journal of Managed Care.

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