Pharmacy Benefit Management Institute (PBMI) helps industry professionals manage pharmacy benefit programs through research-based drug benefit education.

Generic drugs, as safe and efficacious as their brand-name equivalents, are highly effective in reducing the costs of delivering drug benefit programs. The aggressive marketing and advertising efforts of pharmaceutical companies to promote the prescribing of brand-name drugs cause physicians to frequently use more costly second-line agents in lieu of cost-effective, generic first-line agents. This translates to millions of dollars spent on brand-name drugs that could be reduced by using generic drugs. Every one percent increase in generic drug utilization generates savings of $1.16 billion nationwide, according to the Generic Pharmaceutical Association.

The target audience is plan members and prescribers.

Express Scripts, Inc.'s goal was to incrementally increase generic dispensing rates in commercial populations with strong baseline dispensing rates. To achieve this, the solution needs to:

Using Express Scripts' Zero Dollar Copy Program, plan members who switch from using a higher-cost branded drug to a lower-cost generic in certain therapy classes can have their prescription copayment waived by their plan sponsors for six months. The program has been used effectively in several drug therapy classes including angiotensin receptor blockers, cholesterol-lowering medications, nonsteroidal anti-inflammatories including COX-II inhibitors, and proton pump inhibitors.

The program is a member-friendly solution to successfully shift appropriate utilization to generic drugs. The program spurs a conversation between members and their physicians about the right drug and the members' out-of-pocket costs.

Express Scripts worked with ConnectiCare, a Connecticut-based HMO with 270,000 to use the Zero Dollar Copay Program for HMGs, a cholesterol-lowering drug therapy class. ConnectiCare sent Zero Dollar Copay information to more than 3,200 members who were using low-dose, brand-name cholesterol-lowering drugs. An information package sent to members included a Zero Dollar Copay overview, information on potential savings if their physician changed their prescription to lovastatin (generic Mevacor^®), and additional information to share with their physician. Letters also were sent to physicians to encourage the use of generic drugs when medically appropriate.

After a year of success with the Zero Dollar Copay Program, Express Scripts is implementing it with more traditional trend management approaches such as step therapy and prior authorization to target those members who have not taken advance of newer generic drugs on the market and to continue to increase the generic dispensing rates for both retail and mail prescriptions.

ConnectiCare realized a savings of $200 per member for each patient who switched to the generic using the Zero Dollar Copay Program. As a result of the program, 5.7% of the members switched to lovastatin.

Express Scripts reports good member satisfaction levels and physician support for the Zero Dollar Copay Program. The company is now testing the impact of adding outbound phone calls to coincide with member and provider mailings to increase conversion rates.

There are some classes where the per-member savings is up to $800. The launch of the Zero Dollar Copay Program builds upon increased utilization of generic drugs across the Express Scripts' client base. In 2003, the generic dispensing rate was 48% for retail and mail prescriptions which reflects a 5% increase over the prior year. Express Scripts' overall generic dispensing rate increased to 52% for all of 2004.

For more information about increasing generic dispensing rates in commercial populations, contact Derrell Carter at derrell.carter@express-scripts.com.