Dose Consolidation Reduces Drug Cost

Dose Consolidation Reduces Drug Cost

The Challenge

When patients are asked to take multiple daily doses of behavioral health medication, the cost of therapy increases — and so does the risk of negative medical outcomes due to complex dosing regimens. Still, many providers prescribe multiple daily doses for their patients, rather than a higher-strength tablet or capsule to be taken once-a-day. Identifying and educating these providers and patients can be challenging, making it difficult to capture the potential savings of a once-a-day dosing regimen.

Background

Since behavioral health medications account for more than 13 percent of all Medicaid prescription claims, this state’s Medicaid program wanted to identify ways to cut spending on these drugs.

Commonwealth Medicine’s Clinical Pharmacy Services designed a program to combine dosage consolidation and quantity limitation protocols for the lower strengths of five frequently prescribed, brand-name behavioral health medications:

  • Abilify
  • Zyprexa
  • Effexor-XR
  • Lexapro
  • Zoloft

We converted multi-dose regimens to an equivalent dose — with a higher-strength tablet or capsule taken only once a day.

Our consulting team then evaluated patient utilization and cost outcomes under the new program, which is designed to improve patient adherence and reduce medication costs.

Solution

To determine the extent of the problem, Commonwealth Medicine’s clinical consultants looked at three months of data to identify potential dosage consolidation opportunities for Abilify, Zyprexa, Effexor-XR, Lexapro, and Zoloft. They found that 418 patients were taking lower-strength forms of these products multiple times per day — even though higher strength, single-dose forms of the same products were readily available.  

Commonwealth Medicine’s team embarked on a prescriber education program and sent patient-specific, pharmacist-reviewed mailings to 250 physicians. Personalized letters provided specific information and included a Physician Response Form to track whether the physicians took action as a result of the dose consolidation initiative. Physicians also received a prior authorization request form to return if keeping the patient on the current dosage form and/or regimen was clinically justified.

Results

By comparing pharmacy claims data from before and after the implementation of the Drug Utilization Review Board’s rule changes, our pharmacy team found that dose consolidation and quantity limitation initiatives decreased utilization and cost for the five behavioral health drugs.

  • The Medicaid program saved more than $310,000 in a six-month period.
  • 51 percent of physicians agreed to change their prescribing regimens to a higher strength of the medication to be administered once each day.

Commonwealth Medicine’s findings suggest that using the same methodology across other therapeutic areas, such as asthma, insomnia, and heart disease, would likely result in additional cost-savings and improved patient adherence.