Portal de Periódicos da CAPES

A Cost Analysis of Four Benefit Strategies for Managing a Cox II Inhibitor

2001; Academy of Managed Care Pharmacy; Volume: 7; Issue: 3 Linguagem: Inglês

10.18553/jmcp.2001.7.3.224

1944-706X

Gregory A. Tucker, Andrea Moore, Deborah Avant, Merlyn Monteiro,

Pharmaceutical Economics and Policy

A Cost Analysis of Four Benefit Strategies for Managing a Cox II Inhibitortried and failed before celecoxib was used; • a therapeutic buy-up program, in which a maximum allowable cost is implemented with the member paying the difference; or • a three-tiered copayment plan, in which celecoxib is placed in the highest tier with other nonformulary medications.nn MethodsReports showing paid claims were run using the Apothequery prescription data software, a patented API product.These reports, which contained data from four of API's clients, showed each claim processed, information about patient copayments, days supply, quantity dispensed, ingredient costs paid, the date each prescription was filled, and medication strength.For claims that were denied and never subsequently paid, requests were submitted to the information technology department for retrieval of these data.Claims that were submitted and subsequently reversed were "scrubbed" and discarded.Corresponding data reports were manipulated using Excel spreadsheet software when necessary.The four clients examined varied in size, demographics, and benefit design.Data from a 36,000-member indemnity plan that uses a three-tiered copayment program were gathered and examined.The lowest tier, corresponding to generic drugs, requires a $7 copayment.Preferred brand-name drugs, the second tier, require a $15 copayment.Celecoxib is placed on the third tier, nonpreferred brand-name drugs, which requires a $25 copayment.This type of program discourages use of nonpreferred drugs, but allows the patient access to the medication if he or she is willing to pay the price.Using Excel software, all $25 copayments were changed to $15, thus showing a theoretical total copayment and a theoretical total amount paid had the third tier not been implemented.The difference between the theoretical amount paid and the actual amount paid was determined, and a percentage savings was calculated.The three-tier copayment saves this plan 17.1% compared to the amount that would have been paid had the third tier not been implemented.Data from a 142,000-member group with a therapeutic buyup plan were gathered and examined.In this type of plan, the insurer selects a limited number of preferred products in a given therapeutic class.The member pays the difference between the cost of the nonpreferred product and the preferred product, plus the appropriate copayment.In order for a member to receive celecoxib, a nonpreferred product, the member must pay a $20 copayment plus the difference of the cost of the medication, using generic naproxen as the comparison.Again, this discourages use of the drug, but allows access to patients willing to pay the price.Using Excel software, all copayments greater than $20 were normalized to $20, resulting in a theoretical total copayment and a theoretical total amount paid had the use of celecoxib not been restricted.The difference between the theoretical amount paid