Premera takes aim at high prescription drug prices

prescription drug prices Friday, April 28, 2017

A new Premera program gives customers and their doctors information to avoid high prescription drug prices. The program saved customers more than $5 million in its first 6 months.

Here's how it works:

  1. Premera's pharmacy team scans customer claims for unusual price spikes for prescription drugs.
  2. When a drug price hits a specific cap, we start a rapid-response team. They determine if lower-cost options are available that could provide the same results.
  3. The team initiates communications with doctors and customers to notify them about their options. Those options could include generic drugs or lower-priced brands.
  4. Doctors have the choice to discuss similar treatment options with their patients when it's appropriate.

“When we find a drug with a large price change, we now can take immediate action to assist our customers and their doctors to find a clinically appropriate, more affordable alternative,” said Premera Pharmacy Manager Dan Danielson.

Sometimes Premera puts pre-approval requirements in place for the more expensive drug. That causes doctors to explain why the costlier drug is necessary. This may seem inconvenient, but it also may save customers money if they haven't already tried an alternative drug.

“This gives us time to contact prescribing doctors and let them know of the change,” Danielson said. “When we learn of an eye-popping price increase, we can encourage doctors to move their patients to alternative therapies as soon as possible.”

You may pay less when you pick up your prescription at the pharmacy. That's especially true if you have a high-deductible health plan. 

But even if you pay the same amount, the change could mean you pay less for your healthcare. When more customers choose lower-cost alternatives, it helps keep premium prices lower for everyone.

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A $500,000 increase in drug spending is enough to trigger a premium rate increase. This program aims to inform customers and their doctors about their options before that happens by addressing increases of at least $50,000. That could be a very common drug with a small price increase or a more rare treatment that's quadrupled in price.

For more information on what Premera is doing to help customers with rising prescription drug prices:

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