As the COVID-19 crisis puts more families and companies under serious financial strain, no one should have to pay $3,000 for a different form of a drug that’s only 10 bucks!
You can’t make this stuff up. Yet it happens every day, and usually goes unnoticed. But we noticed. And so did an Rx Savings Solutions member. A four-figure jump in prescription cost gets your attention pretty quickly.
Here’s What Happened:
An 18-year-old dependent on his parent’s employer-sponsored health plan had been taking 100 mg and 25 mg Lamotrigine tablets to treat seizures.
He always paid $5 or $10 per fill for standard tablets of each dose (for at least 2 years, as far back as the claims data go). The cost was the same for the employer.
In August 2018, the same doctor who wrote the original prescriptions changed both to orally disintegrating tablets (ODT).
Our member’s copay price remained at $10 for both. However, suddenly the employer was on the hook for $1,260 and $1,504 per fill, respectively. It stayed that way for a full 16 months, untilâ¦
January 2020, with a new plan option and a reset deductible, the member’s out-of-pocket cost soared to $1,153 and $1,072 per fill.
How we helped:
Once the plan’s January pharmacy claims entered our system, we generated a Savings Alert for the 100 mg ODT prescription and sent the member an email notification. It was a simple, no-brainer: switch back to standard 100 mg tablets.
The member logged in, clicked “Contact My Prescriber,” and by the next fill had a $9.25 prescription waiting for him. Once his deductible is met, the employer will enjoy the $1,100+ savings every fill.
Shortly thereafter, we received the claim for the 25 mg ODT and sent another Savings Notification. Due to the enormous plan savings opportunity, it triggered an Rx Rewards alert that incentivizes behavior change with a $100 VISA¨ Prepaid Card.
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As you can see above, the prescription switch has already been approved by the doctor. Now the employer plan will save $1,955 on each successive fill. Done!
Real Change Happens, One Member at Time
The fact that 25 mg costs more than 100 mg of the same drug is crazy. That a dissolving tablet is 24 times more expensive than a chewable is outrageous, and just plain wrong. That’s America’s pharmacy system, folks.
Our member told us he never had difficulty swallowing the standard tablets. He said his doctor thought the ODT was inexpensive. Most providers have no idea, at least not yet. How could they with the way retail prices vary in this country?
This story both highlights the struggle and underscores the value of high deductibles. Had our member not been hit with two separate four-figure prescription bills, the employer-sponsored plan would likely still be shelling out several thousand dollars each fill unnecessarily.
Instead, the member felt the pain once, leveraged a valuable tool at his disposal, saved his family a couple grand, and now the employer is saving many times that—all with the same drug!
You truly can’t make this stuff up. But we can rid the system of this ridiculous waste. Rx Savings Solutions is doing that, one member at a time.
