2016 shed light on the pharmacy benefits industry and the blurred process behind drug pricing. Knowledge is the first step toward transparency, and we move into the New Year with hope that the recent attention will bring more clarity to PBM practices – eventually leading to meaningful change.

An article by STAT News discusses how “in the wake of mounting anger over Rx drug costs,” the Senate Special Committee on Aging is now taking steps to speed up the regulatory review of generics. The media attention is not only drawing the eyes of the American people, but also the White House. As Washington is urged to take action against some drug manufacturer’s practices of raising drug prices without inferred research or development costs, many physicians continue to prescribe these drugs, despite the price increases. And your PBM is profiting by having them covered on your formulary!  

Recently, two very well-known PBMs secured formulary status for a brand drug called “Duexis,” currently selling for over $4,000. Yes, that is thousands for a 90-day supply. Duexis is a combination of two drugs you likely have in your medicine cabinet that cost only a few bucks combined – ibuprofen and famotidine (common household names, Motrin and Pepcid). Similarly, Vimovo is another expensive combination drug using Omeprazole delayed-release and Naproxen Sodium (AKA Aleve). Using our proprietary ClaimWatch Rx system, we pulled data to show the drastic difference in pricing with comparable drugs.

Actual Data from CCRx

Cost of Duexis: 270 pills, 90-day supply, $ 4,680     

Cost of Ibuprofen and Famotidine (generic/OTC versions), 90-day supply: $20 to $40

Cost of Vimovo: 180 pills, 90-day supply: $ 2,279  

Cost of Omeprazole delayed-release and Naproxen Sodium (generic/OTC versions), 90-day supply: $20 to $40

Unfortunately, there are other companies like these who are doing the same. Check out more on the matter at by NCPA. If you do not want to pay these prices then try talking with your PBM about the need to cover these products for your employees.     

Another option is to work with a company like Crystal Clear Rx (CCRx). CCRx’s state-of-the-art, proprietary software called “ClaimWatchRx” pulls all of your company’s current pricing and drug utilization data and compares that information with better options available in the market as shown above. In addition to utilizing this tool, we also advise our clients to remove products like Duexis or Vimovo from their plans and cover the over-the-counter products or generics for a fraction of the cost.

Our hope for 2017 is that the U.S. media and companies like ours will continue to bring awareness to this issue and help companies achieve true transparency in their pharmacy benefits.

In the meantime, if you have any questions about your current drug pricing, please feel free to reach out to us anytime at 303-955-7827 or visit CrystalClearRx.com