November 02, 2016

Another Look: Combination Drugs

, Network Solutions


Mainstream media’s headlines are filled with stories about prescription drug costs. Recently, on the group health side, Mylan’s EpiPens have seen price increases from $100 in 1999 to $1,000 in 2016. Other high profile examples include Turing Pharmaceutical’s AIDS medication Daraprim that saw a 5,000% price increase and Valeant’s price increases for life-saving heart drugs, which sparked Congressional investigations and the dismissal of its CEO.

A few months ago, our blog featured an article about combination drugs, drugs that are created when a manufacturer combines two or more active medications to a single new, FDA approved drug. While arguably more convenient, these combination drugs can also be 5-7 times more expensive.

Most recently, an article on Monday in the Wall Street Journal featured a story of the same saga, in addition to specifically addressing combination medications. Saying there’s an overcharge issue across the pharmacy industry right now is an understatement, and the same goes for the workers’ compensation industry – an epidemic is taking place.

Our article highlighted Duexis, an increasingly popular drug prescribed by physicians treating injured workers. Duexis combines two generic ingredients into a single pill. Ibuprofen is an anti-inflammatory used to address pain, and the famotidine is an antacid used to prevent stomach ulcers caused by the ibuprofen. The cost of a single pill of Duexis is $16, six times the cost of the two generic pills that total $2.50.

Unlike the Wall Street Journal article, which showcased what some have done to offset combination drug premiums by doing the one-to-two conversion on their own initiative, in workers' compensation, this all falls to the payer.

Doctors are constantly marketed by drug representatives who extol the convenience and efficacy of their products. And because doctors are busy with patients and paperwork, they may prescribe drugs like Duexis and have no idea how much they cost. On the pharmacy side, pharmacy benefits management (PBM) automation, which helps keep patients safe by identifying dangerous drug combinations, and converts multi-source brand drugs to their generic equivalents, unfortunately does not address combination drugs. System logic works perfectly for one-to-one conversions but does not support a one-to-two conversion, and therefore combination drugs are a problem. 

The traditional PBM approach to address combination drugs is to mail prescribing doctors “conversion letters” requesting a change to the prescription and conversion to the two generics. Unfortunately, these letters are too little too late – the script is already filled and out the door.

To successfully convert a combination drug, a higher level of service is required. CorVel’s system flags all combination drugs in our formulary, stopping the pharmacy from dispensing and requiring the pharmacy to call CorVel for approval to dispense. CorVel’s Certified Pharmacy Technicians reach out to the prescribing physician to receive a verbal authorization to make the conversion. This high touch model saves clients more money and is the reason prospective management adds higher value.

With system edits, expert resources, and a higher level of service, CorVel can prevent combination drugs like Duexis from being filled in the first place. In all cases, CorVel is committed to providing prospective and clinically appropriate management to manage clients’ exposure and costs.

To learn more about CorVel’s pharmacy program, visit their website. Read one of CorVel’s case studies that illustrates how they were able to deliver $14,000 in savings to one of their clients for a single compound.