Magazine article Drug Topics

PBM Encouraging OTC Use to Counter Medication Costs

Magazine article Drug Topics

PBM Encouraging OTC Use to Counter Medication Costs

Article excerpt

Can insurance companies persuade patients to use over-thecounter drugs instead of prescription medicines to treat seasonal allergies and chronic pain? Interim data from a study by Prescription Solutions, a pharmacy benefit management (PBM) firm based in Cypress, Calif., demonstrates that this can be done safely and effectively and result in costsavings for both patient and insurer.

For the past six months, Prescription Solutions has been conducting a study with two large medical practice groups in Southern California. The PBM is trying to encourage the use of therapeutically equivalent OTC drugs instead of higher-priced prescription drugs.

Their findings may be especially helpful to senior citizens who have a cap on their prescription drug benefit as well as to other patients with capitated prescription benefits. Substituting appropriate OTC drugs can help optimize benefit dollars by keeping patients from reaching benefit limits too quickly. Prescription Solutions also believes that the utilization of OTC drugs may have a health benefit for members, because many OTCs cause fewer side effects than their prescription counterparts.

Because OTC drugs are not covered by most health plans, Prescription Solutions included, patients are often reluctant to use OTCs instead of the prescription drugs for which they are reimbursed. To address this obstacle, Prescription Solutions tried to ensure that patients in the study would not incur any expenses beyond their copayment for prescription drugs. …

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