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High OOP likely behind decline-to-fill rates for MS

Medicare & Reimbursement Advisor Weekly, June 17, 2009

Formulary prescribing rates to be tracked

One in four multiple sclerosis (MS) patients are declining to fill their prescriptions, likely due to high out-of-pocket costs, according to research from Prime Therapeutics. The study found that patients with an out-of-pocket expense greater than $250 were seven times more likely to decline to fill their prescription than patients with an out-of-pocket cost of $100 or less. According to the study, the majority of individuals had an out-of-pocket expense of $150 or less and their decline-to-fill rate was 5.8%. For individuals with an out-of-pocket expense greater than $150, the decline-to-fill rate was 27%. MS specialty medications have a typical average wholesale price of $2,500 per month supply, or $30,000 annually, says Prime Therapeutics.

Formulary prescribing rates to be tracked

The California Public Employees’ Retirement System, Anthem Blue Cross, Medco Health Solutions, and Blue Shield of California have launched the state’s largest e-prescribing initiative to date. The pilot program will use input from participating physicians to determine the best ways to employ e-prescribing technology in their practices and by all prescribers. Program organizers will track results such as the number of identified preventable adverse drug events, use of e-prescribing, and generic drug and formulary prescribing rates.

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