A hepatitis C drug treatment costs $84,000. The cost of a diabetes medication goes up by 325 percent. An EpiPen price hike results in an uproar—and a congressional hearing. Events like these are causing drug prices to soar and forcing companies and their employees to foot the bill. But Kaiser Permanente is helping employers fight back. Recently, national and local business and health care leaders came together in Seattle to take part in The Prescription and Specialty Drug Forum, an event hosted by by Kaiser Permanente (as Group Health). The forum gave employers the opportunity to learn what they can do to help reduce the impact that pharmacy costs have on their health care spend.
What Employers Are Looking For
Guest speaker Jonathan Hensley brought a unique viewpoint to the event. As former head of Regence Blue Shield in Washington and current president and chief strategy officer at Capital Benefits, he has seen the issue from both health plan and company perspectives.
“What I see from our clients right now is a heightened visibility. They’re well aware that pharmacy costs have gone from lower level single digits not that long ago to making up 18, 19, and possibly 20 percent of their health care costs. Clients are looking for a partner to take action on their behalf.
“So we’re looking to work with health care organizations that see things in a very integrated way. We don’t look at pharmacy as a stand-alone. Care has to be coordinated, medications managed, and doctors have to look to prescribe less costly but equally effective drugs. This is where Group Health shines.”
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What Kaiser Permanente is Doing
In support of Mr. Hensley’s view, Marc Mora, MD, Kaiser Permanente chief medical officer, provided concrete examples of what Kaiser Permanente is doing to help manage rising prescription and specialty drug costs.
Pharmacy expertise. New drugs hit the market every day. Kaiser Permanente has pharmacy experts in place in multiple sclerosis, complex oncology, and other complicated areas to offer guidance on which medications are best for which conditions.
Specialty drug programs. Kaiser Permanente has specialty programs for patients taking medicines in the following drug categories: oral oncology, hepatitis c, multiple sclerosis, biologics for rheumatoid arthritis, HIV, and pulmonary arterial hypertension (PAH).
Coordinated care. Kaiser Permanente doctors, nurses, and pharmacists all have access to a patient’s electronic medical records. Drug interactions are avoided by having full knowledge of a patient’s prescription history. Getting medication prescribed right the first time keeps costs down.
Meticulous dosing. Instead of having a patient pay for an expensive 30-day prescription, we’ll give them a 5-day dose to make sure they tolerate the medication and that it works as desired.
Effectiveness and adherence. Some medications represent a significant investment for a patient and their health plan. Our pharmacy teams reach out to monitor potential side effects, as well as to make sure the patients are taking the medications as prescribed for maximum effectiveness.
Accessibility. Pharmacy, Consulting Nurse, and Emergency MD teams are available by phone 24/7 to provide answers to questions from care teams—and patients—about medications, dosing, tolerance, and possible reactions.
The result is providing the right prescription at the right time for the right cost.
What Employers Can Do
Most will agree that there is no simple fix to the dramatic rise in specialty drug prices and the impact pharmacy charges are having on employers’ health plan costs. It will take the combined efforts of employers, legislators, health plans, producers, and pharmaceutical companies to arrive at an equitable solution.